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Caversaccio M, Wimmer W, Anso J, Mantokoudis G, Gerber N, Rathgeb C, Schneider D, Hermann J, Wagner F, Scheidegger O, Huth M, Anschuetz L, Kompis M, Williamson T, Bell B, Gavaghan K, Weber S. Robotic middle ear access for cochlear implantation: First in man. PLoS One 2019; 14:e0220543. [PMID: 31374092 PMCID: PMC6677292 DOI: 10.1371/journal.pone.0220543] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 07/18/2019] [Indexed: 11/18/2022] Open
Abstract
To demonstrate the feasibility of robotic middle ear access in a clinical setting, nine adult patients with severe-to-profound hearing loss indicated for cochlear implantation were included in this clinical trial. A keyhole access tunnel to the tympanic cavity and targeting the round window was planned based on preoperatively acquired computed tomography image data and robotically drilled to the level of the facial recess. Intraoperative imaging was performed to confirm sufficient distance of the drilling trajectory to relevant anatomy. Robotic drilling continued toward the round window. The cochlear access was manually created by the surgeon. Electrode arrays were inserted through the keyhole tunnel under microscopic supervision via a tympanomeatal flap. All patients were successfully implanted with a cochlear implant. In 9 of 9 patients the robotic drilling was planned and performed to the level of the facial recess. In 3 patients, the procedure was reverted to a conventional approach for safety reasons. No change in facial nerve function compared to baseline measurements was observed. Robotic keyhole access for cochlear implantation is feasible. Further improvements to workflow complexity, duration of surgery, and usability including safety assessments are required to enable wider adoption of the procedure.
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Affiliation(s)
- Marco Caversaccio
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Hearing Research Laboratory, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Wilhelm Wimmer
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Hearing Research Laboratory, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Juan Anso
- Image-Guided Therapy, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Georgios Mantokoudis
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Nicolas Gerber
- Image-Guided Therapy, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Christoph Rathgeb
- Hearing Research Laboratory, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Daniel Schneider
- Image-Guided Therapy, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Jan Hermann
- Image-Guided Therapy, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Franca Wagner
- Department of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Olivier Scheidegger
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Markus Huth
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Lukas Anschuetz
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Martin Kompis
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Tom Williamson
- Image-Guided Therapy, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Brett Bell
- Image-Guided Therapy, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Kate Gavaghan
- Image-Guided Therapy, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Stefan Weber
- Image-Guided Therapy, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
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Schieferbein V, Bredemann J, Schmitt R, Stenin I, Klenzner T, Schipper J, Kristin J. Influence of patient-specific anatomy on medical computed tomography and risk evaluation of minimally invasive surgery at the otobasis. Eur Arch Otorhinolaryngol 2018; 276:375-382. [PMID: 30554360 DOI: 10.1007/s00405-018-5249-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 12/12/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE With the increasing use of new minimally invasive approaches in temporal bone surgery, the need arises for evaluation of the risk of injury to sensitive anatomical structures. The factors that influence the measurement uncertainty (variation in representation of position and shape of anatomical structures) of imaging are of relevance. We investigate the effect of patients' anatomy on the measurement uncertainty of medical CT. METHODS Six formalin-fixed temporal bones were used, fiducial markers were bone-implanted, and 20 CT scans of each temporal bone were generated. Surgically threatened anatomical structures of importance were defined. Manual segmentation was performed to create 3D surface models, and different Gaussian filters were applied. Analysis points were established along the border of the superior semicircular canal to determine the deviation between the 3D images of the labyrinth. The standard uncertainty was calculated, and one-way analysis of variance was performed (significance level = 5%) to evaluate the effect of certain factors (patient, side, Gaussian filter) on the measurement uncertainty. RESULTS The influence of patient-specific anatomy on the measurement uncertainty of medical CT (p = 0.049) was demonstrated for the first time. The applied Gaussian filter (p = 0.622) and the patient's side (p = 0.341) showed no significant effect. CONCLUSION The applied method and the results of the statistical analysis suggest that the patient's individual anatomical conditions affect the measurement uncertainty of medical CT. Thus, the patient's anatomy must be considered as an important influencing factor during risk evaluation concerning minimally invasive and image-guided surgery.
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Affiliation(s)
- Vanessa Schieferbein
- Department of Otorhinolaryngology, University Hospital Duesseldorf, Duesseldorf, Germany.
| | - Judith Bredemann
- Laboratory for Machine Tools and Production Engineering WZL, Chair of Production Metrology and Quality Management, RWTH Aachen University, Aachen, Germany
| | - R Schmitt
- Laboratory for Machine Tools and Production Engineering WZL, Chair of Production Metrology and Quality Management, RWTH Aachen University, Aachen, Germany
| | - I Stenin
- Department of Otorhinolaryngology, University Hospital Duesseldorf, Duesseldorf, Germany
| | - T Klenzner
- Department of Otorhinolaryngology, University Hospital Duesseldorf, Duesseldorf, Germany
| | - Jörg Schipper
- Department of Otorhinolaryngology, University Hospital Duesseldorf, Duesseldorf, Germany
| | - Julia Kristin
- Department of Otorhinolaryngology, University Hospital Duesseldorf, Duesseldorf, Germany
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