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Abari J, Heuninck E, Topsakal V. Entirely robotic cochlear implant surgery. Am J Otolaryngol 2024; 45:104360. [PMID: 38754261 DOI: 10.1016/j.amjoto.2024.104360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Accepted: 04/25/2024] [Indexed: 05/18/2024]
Abstract
INTRODUCTION Robot-assisted cochlear implant surgery (RACIS) as defined by the HEARO®-procedure performs minimal invasive cochlear implant (CI) surgery by directly drilling a keyhole trajectory towards the inner ear. Hitherto, an entirely robotic automation including electrode insertion has not been described yet. The feasability of using a newly developed, dedicated motorised device for automated electrode insertion in the first clinical case of entirely robotic cochlear implant surgery was investigated. AIM The aim is to report the first experience of entirely robotic cochlear implantation surgery. INTERVENTION RACIS with a straight flexible lateral wall electrode. PRIMARY OUTCOME MEASUREMENTS Electrode cochlear insertion depth. SECONDARY OUTCOME MEASUREMENTS The audiological outcome in terms of mean hearing thresholds. CONCLUSION Here, we report on a cochlear implant robot that performs the most complex surgical steps to place a cochlear implant array successfully in the inner ear and render similar audiological results as in conventional surgery. Robots can execute tasks beyond human dexterity and will probably pave the way to standardize residual hearing preservation and broadening the indication for electric-acoustic stimulation in the same ear with hybrid implants.
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Affiliation(s)
- Jaouad Abari
- Department of Otorhinolaryngology Head and Neck Surgery, University Hospital UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium.
| | - Emilie Heuninck
- Department of Otorhinolaryngology Head and Neck Surgery, University Hospital UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Vedat Topsakal
- Vrije Universiteit Brussel, Brussels Health Campus, Brussels, Belgium
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Schoovaerts M, Ourak M, Borghesan G, Putzeys T, Poorten EV, Verhaert N. OCT-based intra-cochlear imaging and 3D reconstruction: ex vivo validation of a robotic platform. Int J Comput Assist Radiol Surg 2024:10.1007/s11548-024-03081-7. [PMID: 38436923 DOI: 10.1007/s11548-024-03081-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 02/15/2024] [Indexed: 03/05/2024]
Abstract
PURPOSE The small size of the cochlea, and its location deeply embedded in thick temporal bone, poses a challenge for intra-cochlear guidance and diagnostics. Current radiological imaging techniques are not able to visualize the cochlear microstructures in detail. Rotational optical coherence tomography (OCT) fibers show great potential for intra-cochlear guidance. The generated images could be used to map, and study, the tiny cochlear microstructures relevant for hearing. METHODS This work describes the design of a rotational OCT probe with an outer diameter of 0.9 mm. It further discusses a robotic system, which features a remote center of motion mechanism, dedicated to the probe's positioning, fine manipulation and stable insertion into the cochlear micro-spaces. Furthermore, the necessary calibration steps for 3D reconstruction are described, followed by a detailed quantitative analysis, comparing the 3D reconstructions using a synthetic, 2:1 scaled scala tympani model with a reconstruction from micro-CT, serving as the ground truth. Finally, the potential of the system is demonstrated by scanning a single ex vivo cadaveric human cochlea. RESULTS The study investigates five insertions in the same 2:1 scaled tympani model, along with their corresponding 3D reconstruction. The comparison with micro-CT results in an average root-mean-square error of 74.2 µm, a signed distance error of 38.1 µm and a standard deviation of 63.6 µm. The average F-score of the reconstructions, using a distance threshold of 100 and 74.2 µm, resulted in 83.0% and 71.8%, respectively. Insertion in the cadaveric human cochlea showed the challenges for straight insertion, i.e., navigating the hook region. CONCLUSION Overall, the system shows great potential for intra-cochlear guidance and diagnostics, due to the system's capability for precise and stable insertion into the basal turn in the scala tympani. The system, combined with the calibration procedure, results in detailed and precise 3D reconstructions.
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Affiliation(s)
- Maarten Schoovaerts
- Department of Mechanical Engineering, KU Leuven, Celestijnenlaan 300, 3001, Leuven, Belgium.
- Department of Neurosciences, KU Leuven, Herestraat 49, 3001, Leuven, Belgium.
| | - Mouloud Ourak
- Department of Mechanical Engineering, KU Leuven, Celestijnenlaan 300, 3001, Leuven, Belgium
| | - Gianni Borghesan
- Department of Mechanical Engineering, KU Leuven, Celestijnenlaan 300, 3001, Leuven, Belgium
- Flanders Make, KU Leuven, Celestijnenlaan 300, 3001, Leuven, Belgium
| | - Tristan Putzeys
- Department of Neurosciences, KU Leuven, Herestraat 49, 3001, Leuven, Belgium
- Department of Physics and Astronomy, KU Leuven, Celestijnenlaan 200, 3001, Leuven, Belgium
| | | | - Nicolas Verhaert
- Department of Neurosciences, KU Leuven, Herestraat 49, 3001, Leuven, Belgium
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Leuven, Herestraat 49, 3001, Leuven, Belgium
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Heuninck E, Van de Heyning P, Van Rompaey V, Mertens G, Topsakal V. Audiological outcomes of robot-assisted cochlear implant surgery. Eur Arch Otorhinolaryngol 2023; 280:4433-4444. [PMID: 37043021 DOI: 10.1007/s00405-023-07961-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 04/03/2023] [Indexed: 04/13/2023]
Abstract
PURPOSE The main objective of this study is to evaluate the short-term and long-term audiological outcomes in patients who underwent cochlear implantation with a robot-assisted system to enable access to the cochlea, and to compare outcomes with a matched control group of patients who underwent cochlear implantation with conventional access to the cochlea. METHODS In total, 23 patients were implanted by robot-assisted cochlear implant surgery (RACIS). To evaluate the effectiveness of robotic surgery in terms of audiological outcomes, a statistically balanced control group of conventionally implanted patients was created. Minimal outcome measures (MOM), consisting of pure-tone audiometry, speech understanding in quiet and speech understanding in noise were performed pre-operatively and at 3 months, 6 months, 12 months and 2 years post-activation of the audioprocessor. RESULTS There was no statistically significant difference in pure-tone audiometry, speech perception in quiet and speech perception in noise between robotically implanted and conventionally implanted patients pre-operatively, 3 months, 6 months, 12 months and 2 years post-activation. A significant improvement in pure-tone hearing thresholds, speech understanding in quiet and speech understanding in noise with the cochlear implant has been quantified as of the first measurements at 3 months and this significant improvement remained stable over a time period of 2 years for HEARO implanted patients. CONCLUSION Clinical outcomes in robot-assisted cochlear implant surgery are comparable to conventional cochlear implantation. CLINICALTRAILS. GOV TRAIL REGISTRATION NUMBERS NCT03746613 (date of registration: 19/11/2018), NCT04102215 (date of registration: 25/09/2019).
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Affiliation(s)
- Emilie Heuninck
- Department of Otorhinolaryngology Head and Neck Surgery, University Hospital Brussels, Vrije Universiteit Brussel, Brussels Health Campus, Brussels, Belgium.
| | - Paul Van de Heyning
- Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, Antwerp, Belgium
- Experimental Laboratory of Translational Neurosciences and Dento-Otolaryngology, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Vincent Van Rompaey
- Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, Antwerp, Belgium
- Experimental Laboratory of Translational Neurosciences and Dento-Otolaryngology, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Griet Mertens
- Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, Antwerp, Belgium
- Experimental Laboratory of Translational Neurosciences and Dento-Otolaryngology, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Vedat Topsakal
- Department of Otorhinolaryngology Head and Neck Surgery, University Hospital Brussels, Vrije Universiteit Brussel, Brussels Health Campus, Brussels, Belgium
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Alahmadi A, Abdelsamad Y, Alothman NI, Alshalan A, Almuhawas F, AlAmari NA, Alyousef MY, Alhabib SF, Hagr A. A Literature Review on Cochlear Implant Activation: From Weeks to Hours. EAR, NOSE & THROAT JOURNAL 2023:1455613231188294. [PMID: 37551795 DOI: 10.1177/01455613231188294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023] Open
Abstract
Objectives: The present literature review discusses the chronological evolution of Cochlear Implant (CI) activation and its definition among the relevant studies in the literature. In addition, the benefits of standardizing the early activation process in implantation centers worldwide are discussed. Methods: A comprehensive literature search was conducted in the major databases such as PubMed, Scopus, and Embase to retrieve all the relevant articles that reported early activation approaches following CI. Results: The evolution of the timing of early activation after CI has been remarkable in the past few years. Some studies reported the feasibility of early activation 1 day after the CI surgery in their users. Conclusions: Within the last decade, some studies have been published to report the feasibility and outcomes of its early activation. However, the process of early activation was not adequately defined, and no apparent guidelines could be found in the literature.
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Affiliation(s)
- Asma Alahmadi
- King Abdullah Ear Specialist Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | | | - Noura I Alothman
- Department of Health Communication Sciences, College of Health and Rehabilitation Sciences, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Afrah Alshalan
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Jouf University, Sakaka, Saudi Arabia
| | - Fida Almuhawas
- King Abdullah Ear Specialist Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Nouf A AlAmari
- Otolaryngology-Head & Neck Surgery Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Mohammed Y Alyousef
- Otolaryngology-Head & Neck Surgery Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Salman F Alhabib
- King Abdullah Ear Specialist Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Abdulrahman Hagr
- King Abdullah Ear Specialist Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Müller-Graff FT, Voelker J, Kurz A, Hagen R, Neun T, Rak K. Accuracy of radiological prediction of electrode position with otological planning software and implications of high-resolution imaging. Cochlear Implants Int 2023; 24:144-154. [PMID: 36617441 DOI: 10.1080/14670100.2022.2159128] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVES In cochlear implantation, preoperative prediction of electrode position has recently gained increasing attention. Currently, planning is usually done by multislice CT (MSCT). However, flat-panel volume CT (fpVCT) and its secondary reconstructions (fpVCTSECO) allow for more precise visualization of the cochlea. Combined with a newly developed otological planning software, the position of every single contact can be effectively predicted. In this study it was investigated how accurately radiological prediction forecasts the postoperative electrode localization and whether higher image resolution is advantageous. METHODS Utilizing otological planning software (OTOPLAN®) and different clinical imaging modalities (MSCT, fpVCT and fpVCTSECO) the electrode localization [angular insertion depth (AID)] and respective contact frequencies were predicted preoperatively and examined postoperatively. Furthermore, inter-electrode-distance (IED) and inter-electrode-frequency difference (IEFD) were evaluated postoperatively. RESULTS Measurements revealed a preoperative overestimation of AID. Corresponding frequencies were also miscalculated. Determination of IED and IEFD revealed discrepancies at the transition from the basal to the middle turn and round window to the basal turn. All predictions and discrepancies were lowest when using fpVCTSECO. CONCLUSION The postoperative electrode position can be predicted quite accurately using otological planning software. However, because of several potential misjudgments, high-resolution imaging, such as offered by fpVCTSECO, should be used pre- and postoperatively.
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Affiliation(s)
- Franz-Tassilo Müller-Graff
- Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery and the Comprehensive Hearing Center, University of Wuerzburg, Wuerzburg, Germany
| | - Johannes Voelker
- Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery and the Comprehensive Hearing Center, University of Wuerzburg, Wuerzburg, Germany
| | - Anja Kurz
- Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery and the Comprehensive Hearing Center, University of Wuerzburg, Wuerzburg, Germany
| | - Rudolf Hagen
- Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery and the Comprehensive Hearing Center, University of Wuerzburg, Wuerzburg, Germany
| | - Tilmann Neun
- Institute for Diagnostic and Interventional Neuroradiology, University of Wuerzburg, Wuerzburg, Germany
| | - Kristen Rak
- Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery and the Comprehensive Hearing Center, University of Wuerzburg, Wuerzburg, Germany
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Development and In-Silico and Ex-Vivo Validation of a Software for a Semi-Automated Segmentation of the Round Window Niche to Design a Patient Specific Implant to Treat Inner Ear Disorders. J Imaging 2023; 9:jimaging9020051. [PMID: 36826970 PMCID: PMC9965310 DOI: 10.3390/jimaging9020051] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 02/02/2023] [Accepted: 02/16/2023] [Indexed: 02/22/2023] Open
Abstract
The aim of this study was to develop and validate a semi-automated segmentation approach that identifies the round window niche (RWN) and round window membrane (RWM) for use in the development of patient individualized round window niche implants (RNI) to treat inner ear disorders. Twenty cone beam computed tomography (CBCT) datasets of unilateral temporal bones of patients were included in the study. Defined anatomical landmarks such as the RWM were used to develop a customized 3D Slicer™ plugin for semi-automated segmentation of the RWN. Two otolaryngologists (User 1 and User 2) segmented the datasets manually and semi-automatically using the developed software. Both methods were compared in-silico regarding the resulting RWM area and RWN volume. Finally, the developed software was validated ex-vivo in N = 3 body donor implantation tests with additively manufactured RNI. The independently segmented temporal bones of the different Users showed a strong consistency in the volume of the RWN and the area of the RWM. The volume of the semi-automated RWN segmentations were 48 ± 11% smaller on average than the manual segmentations and the area of the RWM of the semi-automated segmentations was 21 ± 17% smaller on average than the manual segmentation. All additively manufactured implants, based on the semi-automated segmentation method could be implanted successfully in a pressure-tight fit into the RWN. The implants based on the manual segmentations failed to fit into the RWN and this suggests that the larger manual segmentations were over-segmentations. This study presents a semi-automated approach for segmenting the RWN and RWM in temporal bone CBCT scans that is efficient, fast, accurate, and not dependent on trained users. In addition, the manual segmentation, often positioned as the gold-standard, actually failed to pass the implantation validation.
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Ren LJ, Yu Y, Zhang YH, Liu XD, Sun ZJ, Yao WJ, Zhang TY, Wang C, Li CL. Three-dimensional finite element analysis on cochlear implantation electrode insertion. Biomech Model Mechanobiol 2022; 22:467-478. [PMID: 36513945 DOI: 10.1007/s10237-022-01657-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 11/19/2022] [Indexed: 12/14/2022]
Abstract
Studying the insertion process of cochlear implant (CI) electrode array (EA) is important to ensure successful, sufficient, and safe implantation. A three-dimensional finite element (FE) model was developed to simulate the insertion process. The cochlear structures were reconstructed from an average statistical shape model (SSM) of human cochlea. The electrode is simplified as a long and tapered beam of homogeneous elastic materials, contacting and interacting with the stiff cochlear structures. A quasi-static insertion simulation was conducted, the insertion force and the contact pressure between the electrode and the cochlear wall, were calculated to evaluate the smoothness of insertion and the risk of potential cochlear trauma. Based on this model, different EA designs were analyzed, including the Young's modulus, the straight or bended shape, the normal or a more tapped section size. The influence of the insertion angle was also discussed. Our simulations indicate that reducing the EA Young's modulus, tapering and pre-bending are effective ways to ensure safe and successful EA implantation. This model is beneficial for optimizing EA designs and is potentially useful for designing patient-specific CI surgery.
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Affiliation(s)
- Liu-Jie Ren
- Department of Facial Plastic Reconstructive Surgery, ENT Institute, Eye and ENT Hospital, NHC Key Laboratory of Hearing Medicine (Fudan University), Shanghai, 200031, China
| | - Yi Yu
- School of Medical Instrumentation, Shanghai University of Medicine and Health Sciences, Shanghai, 201318, China
| | - Yu-Heng Zhang
- Shanghai Engineering Research Center of Cochlear Implants, Shanghai, 201318, China
| | - Xin-Dong Liu
- Shanghai Engineering Research Center of Cochlear Implants, Shanghai, 201318, China
| | - Zeng-Jun Sun
- Shanghai Engineering Research Center of Cochlear Implants, Shanghai, 201318, China
| | - Wen-Juan Yao
- School of Mechanics and Engineering Science, Shanghai Institute of Applied Mathematics and Mechanics, Shanghai University, Shanghai, 200444, China
| | - Tian-Yu Zhang
- Department of Facial Plastic Reconstructive Surgery, ENT Institute, Eye and ENT Hospital, NHC Key Laboratory of Hearing Medicine (Fudan University), Shanghai, 200031, China
| | - Cheng Wang
- Shanghai Engineering Research Center of Cochlear Implants, Shanghai, 201318, China.
| | - Chen-Long Li
- Department of Facial Plastic Reconstructive Surgery, ENT Institute, Eye and ENT Hospital, NHC Key Laboratory of Hearing Medicine (Fudan University), Shanghai, 200031, China.
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Sprinzl GM, Magele A. Personalized Medicine in Otolaryngology: Special Topic Otology. J Pers Med 2022; 12:jpm12111820. [PMID: 36579531 PMCID: PMC9697707 DOI: 10.3390/jpm12111820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 10/10/2022] [Indexed: 11/06/2022] Open
Abstract
Globally, more than 1.5 billion people experience some degree of hearing loss [...].
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Affiliation(s)
- Georg Mathias Sprinzl
- University Clinic St. Poelten, Department of Otorhinolaryngology, Head & Neck Surgery, Dunant-Platz 1, 3100 St. Pölten, Austria
- Karl Landsteiner Institute of Implantable Hearing Devices, Henri Dunant Platz 1, 3100 St. Pölten, Austria
- Correspondence: ; Tel.: +43-2742-9004-11500
| | - Astrid Magele
- University Clinic St. Poelten, Department of Otorhinolaryngology, Head & Neck Surgery, Dunant-Platz 1, 3100 St. Pölten, Austria
- Karl Landsteiner Institute of Implantable Hearing Devices, Henri Dunant Platz 1, 3100 St. Pölten, Austria
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Robotics and cochlear implant surgery: goals and developments. Curr Opin Otolaryngol Head Neck Surg 2022; 30:314-319. [PMID: 36036531 DOI: 10.1097/moo.0000000000000837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Cochlear implantation (CI) is a viable option for patients with severe sensorineural hearing loss. Advances in CI have focused on minimizing cochlear trauma to improve hearing preservation outcomes, and in doing so expanding candidacy to patients with useful cochlear reserve. Robotics holds promise as a potential tool to minimize intracochlear trauma with electrode insertion, improve surgical efficiency, and reduce surgical complications. The purpose of this review is to summarize efforts and advances in the field of robotic-assisted CI. RECENT FINDINGS Work on robotics and CI over the past few decades has explored distinct surgical aspects, including image-based surgical planning and intraoperative guidance, minimally invasive robotic-assisted approaches mainly through percutaneous keyhole direct cochlear access, robotic electrode insertion systems, robotic manipulators, and drilling feedback control through end effector sensors. Feasibility and safety have been established and many devices are undergoing clinical trials for clinical adoption, with some having already achieved approval of national licensing bodies. SUMMARY Significant work has been done over the past two decades that has shown robotic-assisted CI to be feasible and safe. Wider clinical adoption can potentially result in improved hearing preservation and quality of life outcomes to more CI candidates.
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Alhabib SF, Almuhawas F, Hagr A, Alzhrani F, Hamed N, Alenzi S, Abdelsamad Y, Dhanasingh A. Mastoid Growth and the Configuration of Cochlear Implant Electrode Lead. EAR, NOSE & THROAT JOURNAL 2022:1455613221106221. [PMID: 35861389 DOI: 10.1177/01455613221106221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To study the changes in the coiled configuration of electrode excess lead in the mastoid cavity in the cochlear implant recipients over time. METHODS Post-operative CT scans at two different appointments of fourteen patients with cochlear implants (CI) were retrospectively analyzed using a DICOM viewer software (3D-slicer). Mastoid thickness (MT) was measured in the oblique coronal plane from the round window (RW) entrance to the mastoid edge and inter-cochlear distance (ICD) was measured in the axial plane at the fundus level between two ears. 3D segmentation of the entire inner ear of both sides and coiled electrode excess lead was performed to visually compare the changes in coiled configuration between the two CT scan time points. RESULT MT and ICD increased logarithmically with the patient's age, as has been measured from both the 1st and the 2nd CT scans and a weak linear correlation between MT and ICD was observed. Growth in MT and ICT measured between the time of 1st and 2nd CT scans showed a strong linear correlation. In eight cases, changes in the electrode excess lead have been observed in the 2nd CT scan, either a change in the coiling configuration of electrode excess lead or shifted laterally toward the mastoid edge. The ICD growth between the 1st and the 2nd CT scans was >2 mm in only seven cases and all of them were children. All other six cases had no observed changes in the coiled electrode lead. In addition, the mastoid growth between the 1st and the 2nd CT scan was >2.5 mm in only 4 cases. CONCLUSION Coiled configuration of electrode excess lead could change when the MT and ICD increased over time.
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Affiliation(s)
- Salman F Alhabib
- King Abdullah Ear Specialist Center (KAESC), College of Medicine, ORL Department, King Saud University, Riyadh, Saudi Arabia
| | - Fida Almuhawas
- King Abdullah Ear Specialist Center (KAESC), College of Medicine, ORL Department, King Saud University, Riyadh, Saudi Arabia
| | - Abdulrahman Hagr
- King Abdullah Ear Specialist Center (KAESC), College of Medicine, ORL Department, King Saud University, Riyadh, Saudi Arabia
| | - Farid Alzhrani
- King Abdullah Ear Specialist Center (KAESC), College of Medicine, ORL Department, King Saud University, Riyadh, Saudi Arabia
| | - Nezar Hamed
- King Abdullah Ear Specialist Center (KAESC), College of Medicine, ORL Department, King Saud University, Riyadh, Saudi Arabia
| | - Saad Alenzi
- King Fahad specialized Hospital-Tabuk, Ministry of Health, Saudi Arabia
| | | | - Anandhan Dhanasingh
- MED-EL, Innsbruck, Austria
- Faculty of Medicine and Health Sciences, Department of Translational Neurosciences, University of Antwerp, Antwerp, Belgium
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Ding AS, Lu A, Li Z, Galaiya D, Siewerdsen JH, Taylor RH, Creighton FX. Automated Registration-Based Temporal Bone Computed Tomography Segmentation for Applications in Neurotologic Surgery. Otolaryngol Head Neck Surg 2022; 167:133-140. [PMID: 34491849 PMCID: PMC10072909 DOI: 10.1177/01945998211044982] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE This study investigates the accuracy of an automated method to rapidly segment relevant temporal bone anatomy from cone beam computed tomography (CT) images. Implementation of this segmentation pipeline has potential to improve surgical safety and decrease operative time by augmenting preoperative planning and interfacing with image-guided robotic surgical systems. STUDY DESIGN Descriptive study of predicted segmentations. SETTING Academic institution. METHODS We have developed a computational pipeline based on the symmetric normalization registration method that predicts segmentations of anatomic structures in temporal bone CT scans using a labeled atlas. To evaluate accuracy, we created a data set by manually labeling relevant anatomic structures (eg, ossicles, labyrinth, facial nerve, external auditory canal, dura) for 16 deidentified high-resolution cone beam temporal bone CT images. Automated segmentations from this pipeline were compared against ground-truth manual segmentations by using modified Hausdorff distances and Dice scores. Runtimes were documented to determine the computational requirements of this method. RESULTS Modified Hausdorff distances and Dice scores between predicted and ground-truth labels were as follows: malleus (0.100 ± 0.054 mm; Dice, 0.827 ± 0.068), incus (0.100 ± 0.033 mm; Dice, 0.837 ± 0.068), stapes (0.157 ± 0.048 mm; Dice, 0.358 ± 0.100), labyrinth (0.169 ± 0.100 mm; Dice, 0.838 ± 0.060), and facial nerve (0.522 ± 0.278 mm; Dice, 0.567 ± 0.130). A quad-core 16GB RAM workstation completed this segmentation pipeline in 10 minutes. CONCLUSIONS We demonstrated submillimeter accuracy for automated segmentation of temporal bone anatomy when compared against hand-segmented ground truth using our template registration pipeline. This method is not dependent on the training data volume that plagues many complex deep learning models. Favorable runtime and low computational requirements underscore this method's translational potential.
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Affiliation(s)
- Andy S Ding
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.,Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland, USA
| | - Alexander Lu
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.,Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland, USA
| | - Zhaoshuo Li
- Department of Computer Science, Johns Hopkins University, Baltimore, Maryland, USA
| | - Deepa Galaiya
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jeffrey H Siewerdsen
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland, USA.,Department of Computer Science, Johns Hopkins University, Baltimore, Maryland, USA
| | - Russell H Taylor
- Department of Computer Science, Johns Hopkins University, Baltimore, Maryland, USA
| | - Francis X Creighton
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
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Real-Time Data-Driven Approach for Prediction and Correction of Electrode Array Trajectory in Cochlear Implantation. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12136343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Cochlear implants provide hearing perception to people with severe to profound hearing loss. The electrode array (EA) inserted during the surgery directly stimulates the hearing nerve, bypassing the acoustic hearing system. The complications during the EA insertion in the inner ear may cause trauma leading to infection, residual hearing loss, and poor speech perception. This work aims to reduce the trauma induced during electrode array insertion process by carefully designing a sensing method, an actuation system, and data-driven control strategy to guide electrode array in scala tympani. Due to limited intra-operative feedback during the insertion process, complex bipolar electrical impedance is used as a sensing element to guide EA in real time. An automated actuation system with three degrees of freedom was used along with a complex impedance meter to record impedance of consecutive electrodes. Prediction of EA direction (medial, middle, and lateral) was carried out by an ensemble of random forest, shallow neural network, and k-nearest neighbour in an offline setting with an accuracy of 86.86%. The trained ensemble was then utilized in vitro for prediction and correction of EA direction in real time in the straight path with an accuracy of 80%. Such a real-time system also has application in other electrode implants and needle and catheter insertion guidance.
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Hussain T. Patient Benefit and Quality of Life after Robot-Assisted Head and Neck Surgery. Laryngorhinootologie 2022; 101:S160-S185. [PMID: 35605618 DOI: 10.1055/a-1647-8650] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Robotic systems for head and neck surgery are at different stages of technical development and clinical application. Currently, robotic systems are predominantly used for transoral surgery of the pharynx and larynx. Robotic surgery of the neck, the thyroid, and the middle and inner ear is much less common; however, some oncological and functional outcomes have been reported. This article provides an overview of the current state of robot-assisted head and neck surgery with a special emphasis on patient benefit and postoperative quality of life (QoL). The focus is placed on the role of transoral robotic surgery (TORS) for the resection of oropharyngeal carcinomas. For this application, reported long-term outcomes show functional post-operative advantages for selected oropharyngeal cancer patients after TORS compared to open surgery and primary radiotherapy. Since TORS also plays a significant role in the context of potential therapy de-escalation for HPV-positive oropharyngeal cancer patients, ongoing trials are presented. Regarding the evaluation of the therapeutic benefit and the QoL of cancer patients, special attention has to be paid to the large degree of variability of individual patients' preferences. Influencing factors and tools for a detailed assessment of QoL parameters are therefore detailed at the beginning of this article. Notably, while some robotic systems for ear and skull base surgery are being developed in Europe, TORS systems are mainly used in North America and Asia. In Europe and Germany in particular, transoral laser microsurgery (TLM) is a well-established technology for transoral tumor resection. Future trials comparing TORS and TLM with detailed investigation of QoL parameters are therefore warranted and might contribute to identifying suitable fields for the application of the different techniques.
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Affiliation(s)
- Timon Hussain
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Essen, Universität Duisburg-Essen
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Salcher R, John S, Stieghorst J, Kluge M, Repp F, Fröhlich M, Lenarz T. Minimally Invasive Cochlear Implantation: First-in-Man of Patient-Specific Positioning Jigs. Front Neurol 2022; 13:829478. [PMID: 35547379 PMCID: PMC9082655 DOI: 10.3389/fneur.2022.829478] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 02/16/2022] [Indexed: 11/20/2022] Open
Abstract
A minimally-invasive surgical (MIS) approach to cochlear implantation, if safe, practical, simple in surgical handling, and also affordable has the potential to replace the conventional surgical approaches. Our MIS approach uses patient-specific drilling templates (positioning jigs). While the most popular MIS approaches use robots, the robotic aspect is literally put aside, because our high-precision parallel kinematics is only used to individualize a positioning jig. This jig can then be mounted onto a bone-anchored mini-stereotactic frame at the patient's skull and used to create a drill-hole through the temporal bone to the patient's cochlea. We present the first clinical experience where we use sham drill bits of different diameters instead of drilling into the bone in order to demonstrate the feasibility and accuracy.
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Affiliation(s)
- Rolf Salcher
- Department of Otolaryngology, Hannover Medical School, Hannover, Germany
| | | | | | | | | | - Max Fröhlich
- Department of Otolaryngology, Hannover Medical School, Hannover, Germany
- MED-EL Research Center, Hannover, Germany
| | - Thomas Lenarz
- Department of Otolaryngology, Hannover Medical School, Hannover, Germany
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15
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Van de Heyning P, Roland P, Lassaletta L, Agrawal S, Atlas M, Baumgartner WD, Brown K, Caversaccio M, Dazert S, Gstoettner W, Hagen R, Hagr A, Jablonski GE, Kameswaran M, Kuzovkov V, Leinung M, Li Y, Loth A, Magele A, Mlynski R, Mueller J, Parnes L, Radeloff A, Raine C, Rajan G, Schmutzhard J, Skarzynski H, Skarzynski PH, Sprinzl G, Staecker H, Stöver T, Tavora-Viera D, Topsakal V, Usami SI, Van Rompaey V, Weiss NM, Wimmer W, Zernotti M, Gavilan J. Suitable Electrode Choice for Robotic-Assisted Cochlear Implant Surgery: A Systematic Literature Review of Manual Electrode Insertion Adverse Events. Front Surg 2022; 9:823219. [PMID: 35402479 PMCID: PMC8987358 DOI: 10.3389/fsurg.2022.823219] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 02/09/2022] [Indexed: 12/05/2022] Open
Abstract
Background and Objective The cochlear implant (CI) electrode insertion process is a key step in CI surgery. One of the aims of advances in robotic-assisted CI surgery (RACIS) is to realize better cochlear structure preservation and to precisely control insertion. The aim of this literature review is to gain insight into electrode selection for RACIS by acquiring a thorough knowledge of electrode insertion and related complications from classic CI surgery involving a manual electrode insertion process. Methods A systematic electronic search of the literature was carried out using PubMed, Scopus, Cochrane, and Web of Science to find relevant literature on electrode tip fold over (ETFO), electrode scalar deviation (ESD), and electrode migration (EM) from both pre-shaped and straight electrode types. Results A total of 82 studies that include 8,603 ears implanted with a CI, i.e., pre-shaped (4,869) and straight electrodes (3,734), were evaluated. The rate of ETFO (25 studies, 2,335 ears), ESD (39 studies, 3,073 ears), and EM (18 studies, 3,195 ears) was determined. An incidence rate (±95% CI) of 5.38% (4.4–6.6%) of ETFO, 28.6% (26.6–30.6%) of ESD, and 0.53% (0.2–1.1%) of EM is associated with pre-shaped electrodes, whereas with straight electrodes it was 0.51% (0.1–1.3%), 11% (9.2–13.0%), and 3.2% (2.5–3.95%), respectively. The differences between the pre-shaped and straight electrode types are highly significant (p < 0.001). Laboratory experiments show evidence that robotic insertions of electrodes are less traumatic than manual insertions. The influence of round window (RW) vs. cochleostomy (Coch) was not assessed. Conclusion Considering the current electrode designs available and the reported incidence of insertion complications, the use of straight electrodes in RACIS and conventional CI surgery (and manual insertion) appears to be less traumatic to intracochlear structures compared with pre-shaped electrodes. However, EM of straight electrodes should be anticipated. RACIS has the potential to reduce these complications.
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Affiliation(s)
- Paul Van de Heyning
- Department of Otorhinolaryngology Head and Neck Surgery, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
- Department of Translational Neurosciences, University of Antwerp, Antwerp, Belgium
- *Correspondence: Paul Van de Heyning
| | - Peter Roland
- Department of Otolaryngology, Head & Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Luis Lassaletta
- Hospital Universitario La Paz, Institute for Health Research (IdiPAZ), Madrid, Spain
| | - Sumit Agrawal
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, ON, Canada
| | - Marcus Atlas
- Ear Sciences Institute Australia, Lions Hearing Clinic, Perth, WA, Australia
| | | | - Kevin Brown
- UNC Ear and Hearing Center at Chapel Hill School of Medicine, Chapel Hill, NC, United States
| | - Marco Caversaccio
- Department for ENT, Head and Neck Surgery, Bern University Hospital, Bern, Switzerland
| | - Stefan Dazert
- Department of Otorhinolaryngology-Head and Neck Surgery, Ruhr-University Bochum, St. Elisabeth University Hospital Bochum, Bochum, Germany
| | | | - Rudolf Hagen
- Würzburg ENT University Hospital, Würzburg, Germany
| | - Abdulrahman Hagr
- King Abdullah Ear Specialist Center, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Greg Eigner Jablonski
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Otorhinolaryngology & Head and Neck Surgery, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | | | - Vladislav Kuzovkov
- St. Petersburg ENT and Speech Research Institute, St. Petersburg, Russia
| | - Martin Leinung
- Department of Otolaryngology, Head and Neck Surgery, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Yongxin Li
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Key Laboratory of Otolaryngology Head and Neck Surgery (Capital Medical University), Ministry of Education, Beijing, China
| | - Andreas Loth
- Department of Otolaryngology, Head and Neck Surgery, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Astrid Magele
- Ear, Nose and Throat Department, University Clinic St. Poelten, Karl Landsteiner Private University, St. Poelten, Austria
| | - Robert Mlynski
- Department of Otorhinolaryngology, Head and Neck Surgery, “Otto Körner” Rostock University Medical Center, Rostock, Germany
| | - Joachim Mueller
- Klinik und Poliklinik für Hals-, Nasen- und Ohrenheilkunde, Ludwig-Maximilians-Universitat Munchen, Munchen, Germany
| | - Lorne Parnes
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, ON, Canada
| | - Andreas Radeloff
- Division of Oto-Rhino-Laryngology, Evangelisches Krankenhaus Oldenburg, Research Center of Neurosensory Sciences, University Oldenburg, Oldenburg, Germany
| | - Chris Raine
- Bradford Royal Infirmary Yorkshire Auditory Implant Center, Bradford, United Kingdom
| | - Gunesh Rajan
- Department of Otolaryngology, Head and Neck Surgery, Luzerner Kantonsspital, Luzern, Medical Sciences Department of Health Sciences and Medicine. University of Lucerne, Luzern, Switzerland. Otolaryngology, Head & Neck Surgery, Medical School University of Western Australia, Perth, WA, Australia
| | - Joachim Schmutzhard
- Department of Otorhinolaryngology, Medical University of Innsbruck, Innsbruck, Austria
| | - Henryk Skarzynski
- Department of Teleaudiology and Screening, World Hearing Center of the Institute of Physiology and Pathology of Hearing, Kajetany, Poland
| | - Piotr H. Skarzynski
- Department of Teleaudiology and Screening, World Hearing Center of the Institute of Physiology and Pathology of Hearing, Kajetany, Poland
| | - Georg Sprinzl
- Ear, Nose and Throat Department, University Clinic St. Poelten, Karl Landsteiner Private University, St. Poelten, Austria
| | - Hinrich Staecker
- Kansas University Center for Hearing and Balance Disorders, Kansas City, KS, United States
| | - Timo Stöver
- Department of Otolaryngology, Head and Neck Surgery, University Hospital Frankfurt, Frankfurt am Main, Germany
| | | | - Vedat Topsakal
- Department of ENT HNS, University Hospital Brussels, Brussels, Belgium
| | - Shin-Ichi Usami
- Department of Hearing Implant Sciences, Shinshu University School of Medicine, Nagano, Japan
| | - Vincent Van Rompaey
- Department of Otorhinolaryngology Head and Neck Surgery, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
- Department of Translational Neurosciences, University of Antwerp, Antwerp, Belgium
| | - Nora M. Weiss
- Department of Otorhinolaryngology-Head and Neck Surgery, Ruhr-University Bochum, St. Elisabeth University Hospital Bochum, Bochum, Germany
| | - Wilhelm Wimmer
- Department for ENT, Head and Neck Surgery, Bern University Hospital, Bern, Switzerland
| | - Mario Zernotti
- Catholic University of Córdoba and National University of Córdoba, Córdoba, Argentina
| | - Javier Gavilan
- Hospital Universitario La Paz, Institute for Health Research (IdiPAZ), Madrid, Spain
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Topsakal V, Heuninck E, Matulic M, Tekin AM, Mertens G, Van Rompaey V, Galeazzi P, Zoka-Assadi M, van de Heyning P. First Study in Men Evaluating a Surgical Robotic Tool Providing Autonomous Inner Ear Access for Cochlear Implantation. Front Neurol 2022; 13:804507. [PMID: 35386404 PMCID: PMC8979022 DOI: 10.3389/fneur.2022.804507] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 02/10/2022] [Indexed: 11/17/2022] Open
Abstract
Image-guided and robot-assisted surgeries have found their applications in skullbase surgery. Technological improvements in terms of accuracy also opened new opportunities for robotically-assisted cochlear implantation surgery (RACIS). The HEARO® robotic system is an otological next-generation surgical robot to assist the surgeon. It first provides software-defined spatial boundaries for orientation and reference information to anatomical structures during otological and neurosurgical procedures. Second, it executes a preplanned drill trajectory through the temporal bone. Here, we report how safe the HEARO procedure can provide an autonomous minimally invasive inner ear access and the efficiency of this access to subsequently insert the electrode array during cochlear implantation. In 22 out of 25 included patients, the surgeon was able to complete the HEARO® procedure. The dedicated planning software (OTOPLAN®) allowed the surgeon to reconstruct a three-dimensional representation of all the relevant anatomical structures, designate the target on the cochlea, i.e., the round window, and plan the safest trajectory to reach it. This trajectory accommodated the safety distance to the critical structures while minimizing the insertion angles. A minimal distance of 0.4 and 0.3 mm was planned to facial nerve and chorda tympani, respectively. Intraoperative cone-beam CT supported safe passage for the 22 HEARO® procedures. The intraoperative accuracy analysis reported the following mean errors: 0.182 mm to target, 0.117 mm to facial nerve, and 0.107 mm to chorda tympani. This study demonstrates that microsurgical robotic technology can be used in different anatomical variations, even including a case of inner ear anomalies, with the geometrically correct keyhole to access to the inner ear. Future perspectives in RACIS may focus on improving intraoperative imaging, automated segmentation and trajectory, robotic insertion with controlled speed, and haptic feedback. This study [Experimental Antwerp robotic research otological surgery (EAR2OS) and Antwerp Robotic cochlear implantation (25 refers to 25 cases) (ARCI25)] was registered at clinicalTrials.gov under identifier NCT03746613 and NCT04102215.
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Affiliation(s)
- Vedat Topsakal
- Department of Otorhinolaryngology Head and Neck Surgery, University Hospital UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
- *Correspondence: Vedat Topsakal
| | - Emilie Heuninck
- Department of Otorhinolaryngology Head and Neck Surgery, University Hospital UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | | | - Ahmet M. Tekin
- Department of Otorhinolaryngology Head and Neck Surgery, University Hospital UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Otorhinolaryngology, Klinikum Bad Salzungen, Bad Salzungen, Germany
| | - Griet Mertens
- Department of Otorhinolaryngology, Head and Neck Surgery, Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
| | - Vincent Van Rompaey
- Department of Otorhinolaryngology, Head and Neck Surgery, Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
| | | | | | - Paul van de Heyning
- Department of Otorhinolaryngology, Head and Neck Surgery, Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
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Auinger AB, Riss D, Baumgartner WD, Arnoldner C, Gstöttner W. Robot-assisted cochlear implant surgery in a patient with partial ossification of the basal cochlear turn: a technical note. Clin Otolaryngol 2022; 47:504-507. [PMID: 35286758 PMCID: PMC9314985 DOI: 10.1111/coa.13930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 01/14/2022] [Accepted: 01/30/2022] [Indexed: 12/01/2022]
Affiliation(s)
- Alice Barbara Auinger
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - Dominik Riss
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - Wolf-Dieter Baumgartner
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - Christoph Arnoldner
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - Wolfgang Gstöttner
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
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18
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Robotics, automation, active electrode arrays, and new devices for cochlear implantation: A contemporary review. Hear Res 2022; 414:108425. [PMID: 34979455 DOI: 10.1016/j.heares.2021.108425] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 12/16/2021] [Accepted: 12/23/2021] [Indexed: 01/14/2023]
Abstract
In the last two decades, cochlear implant surgery has evolved into a minimally invasive, hearing preservation surgical technique. The devices used during surgery have benefited from technological advances that have allowed modification and possible improvement of the surgical technique. Robotics has recently gained popularity in otology as an effective tool to overcome the surgeon's limitations such as tremor, drift and accurate force control feedback in laboratory testing. Cochlear implantation benefits from robotic assistance in several steps during the surgical procedure: (i) during the approach to the middle ear by automated mastoidectomy and posterior tympanotomy or through a tunnel from the postauricular skin to the middle ear (i.e. direct cochlear access); (ii) a minimally invasive cochleostomy by a robot-assisted drilling tool; (iii) alignment of the correct insertion axis on the basal cochlear turn; (iv) insertion of the electrode array with a motorized insertion tool. In recent years, the development of bone-attached parallel robots and image-guided surgical robotic systems has allowed the first successful cochlear implantation procedures in patients via a single hole drilled tunnel. Several other robotic systems, new materials, sensing technologies applied to the electrodes, and smart devices have been developed, tested in experimental models and finally some have been used in patients with the aim of reducing trauma in cochleostomy, and permitting slow and more accurate insertion of the electrodes. Despite the promising results in laboratory tests in terms of minimal invasiveness, reduced trauma and better hearing preservation, so far, no clinical benefits on residual hearing preservation or better speech performance have been demonstrated. Before these devices can become the standard approach for cochlear implantation, several points still need to be addressed, primarily cost and duration of the procedure. One can hope that improvement in the cost/benefit ratio will expand the technology to every cochlear implantation procedure. Laboratory research and clinical studies on patients should continue with the aim of making intracochlear implant insertion an atraumatic and reversible gesture for total preservation of the inner ear structure and physiology.
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19
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Mueller F, Hermann J, Weber S, O'Toole Bom Braga G, Topsakal V. Image-Based Planning of Minimally Traumatic Inner Ear Access for Robotic Cochlear Implantation. Front Surg 2021; 8:761217. [PMID: 34901143 PMCID: PMC8655094 DOI: 10.3389/fsurg.2021.761217] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 11/02/2021] [Indexed: 12/12/2022] Open
Abstract
Objective: During robotic cochlear implantation, an image-guided robotic system provides keyhole access to the scala tympani of the cochlea to allow insertion of the cochlear implant array. To standardize minimally traumatic robotic access to the cochlea, additional hard and soft constraints for inner ear access were proposed during trajectory planning. This extension of the planning strategy aims to provide a trajectory that preserves the anatomical and functional integrity of critical intra-cochlear structures during robotic execution and allows implantation with minimal insertion angles and risk of scala deviation. Methods: The OpenEar dataset consists of a library with eight three-dimensional models of the human temporal bone based on computed tomography and micro-slicing. Soft constraints for inner ear access planning were introduced that aim to minimize the angle of cochlear approach, minimize the risk of scala deviation and maximize the distance to critical intra-cochlear structures such as the osseous spiral lamina. For all cases, a solution space of Pareto-optimal trajectories to the round window was generated. The trajectories satisfy the hard constraints, specifically the anatomical safety margins, and optimize the aforementioned soft constraints. With user-defined priorities, a trajectory was parameterized and analyzed in a virtual surgical procedure. Results: In seven out of eight cases, a solution space was found with the trajectories safely passing through the facial recess. The solution space was Pareto-optimal with respect to the soft constraints of the inner ear access. In one case, the facial recess was too narrow to plan a trajectory that would pass the nerves at a sufficient distance with the intended drill diameter. With the soft constraints introduced, the optimal target region was determined to be in the antero-inferior region of the round window membrane. Conclusion: A trend could be identified that a position between the antero-inferior border and the center of the round window membrane appears to be a favorable target position for cochlear tunnel-based access through the facial recess. The planning concept presented and the results obtained therewith have implications for planning strategies for robotic surgical procedures to the inner ear that aim for minimally traumatic cochlear access and electrode array implantation.
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Affiliation(s)
- Fabian Mueller
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Jan Hermann
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Stefan Weber
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | | | - Vedat Topsakal
- Department of Otorhinolaryngology, Head and Neck Surgery, Vrije Universiteit Brussel, Brussels, Belgium.,Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
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20
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Ding AS, Capostagno S, Razavi CR, Li Z, Taylor RH, Carey JP, Creighton FX. Volumetric Accuracy Analysis of Virtual Safety Barriers for Cooperative-Control Robotic Mastoidectomy. Otol Neurotol 2021; 42:e1513-e1517. [PMID: 34325455 PMCID: PMC8595530 DOI: 10.1097/mao.0000000000003309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
HYPOTHESIS Virtual fixtures can be enforced in cooperative-control robotic mastoidectomies with submillimeter accuracy. BACKGROUND Otologic procedures are well-suited for robotic assistance due to consistent osseous landmarks. We have previously demonstrated the feasibility of cooperative-control robots (CCRs) for mastoidectomy. CCRs manipulate instruments simultaneously with the surgeon, allowing the surgeon to control instruments with robotic augmentation of motion. CCRs can also enforce virtual fixtures, which are safety barriers that prevent motion into undesired locations. Previous studies have validated the ability of CCRs to allow a novice surgeon to safely complete a cortical mastoidectomy. This study provides objective accuracy data for CCR-imposed safety barriers in cortical mastoidectomies. METHODS Temporal bone phantoms were registered to a CCR using preoperative computed tomography (CT) imaging. Virtual fixtures were created using 3D Slicer, with 2D planes placed along the external auditory canal, tegmen, and sigmoid, converging on the antrum. Five mastoidectomies were performed by a novice surgeon, moving the drill to the limit of the barriers. Postoperative CT scans were obtained, and Dice coefficients and Hausdorff distances were calculated. RESULTS The average modified Hausdorff distance between drilled bone and the preplanned volume was 0.351 ± 0.093 mm. Compared with the preplanned volume of 0.947 cm3, the mean volume of bone removed was 1.045 cm3 (difference of 0.0982 cm3 or 10.36%), with an average Dice coefficient of 0.741 (range, 0.665-0.802). CONCLUSIONS CCR virtual fixtures can be enforced with a high degree of accuracy. Future studies will focus on improving accuracy and developing 3D fixtures around relevant surgical anatomy.
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Affiliation(s)
- Andy S. Ding
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Biomedical Engineering, Johns Hopkins University Whiting School of Engineering, Baltimore, MD, USA
| | - Sarah Capostagno
- Department of Biomedical Engineering, Johns Hopkins University Whiting School of Engineering, Baltimore, MD, USA
| | - Christopher R. Razavi
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Zhaoshuo Li
- Department of Computer Science, Johns Hopkins University Whiting School of Engineering, Baltimore, MD, USA
| | - Russell H. Taylor
- Department of Computer Science, Johns Hopkins University Whiting School of Engineering, Baltimore, MD, USA
| | - John P. Carey
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Francis X. Creighton
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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21
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Jablonski GE, Falkenberg-Jensen B, Bunne M, Iftikhar M, Greisiger R, Opheim LR, Korslund H, Myhrum M, Sørensen TM. Fusion of Technology in Cochlear Implantation Surgery: Investigation of Fluoroscopically Assisted Robotic Electrode Insertion. Front Surg 2021; 8:741401. [PMID: 34820415 PMCID: PMC8606737 DOI: 10.3389/fsurg.2021.741401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 09/29/2021] [Indexed: 11/29/2022] Open
Abstract
The HEARO cochlear implantation surgery aims to replace the conventional wide mastoidectomy approach with a minimally invasive direct cochlear access. The main advantage of the HEARO access would be that the trajectory accommodates the optimal and individualized insertion parameters such as type of cochlear access and trajectory angles into the cochlea. To investigate the quality of electrode insertion with the HEARO procedure, the insertion process was inspected under fluoroscopy in 16 human cadaver temporal bones. Prior to the insertion, the robotic middle and inner ear access were performed through the HEARO procedures. The status of the insertion was analyzed on the post-operative image with Siemens Artis Pheno (Siemens AG, Munich, Germany). The completion of the full HEARO procedure, including the robotic inner ear access and fluoroscopy electrode insertion, was possible in all 16 cases. It was possible to insert the electrode in all 16 cases through the drilled tunnel. However, one case in which the full cochlea was not visible on the post-operative image for analysis was excluded. The post-operative analysis of the electrode insertion showed an average insertion angle of 507°, which is equivalent to 1.4 turns of the cochlea, and minimal and maximal insertion angles were recorded as 373° (1 cochlear turn) and 645° (1.8 cochlear turn), respectively. The fluoroscopy inspection indicated no sign of complications during the insertion.
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Affiliation(s)
- Greg Eigner Jablonski
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Otorhinolaryngology & Head and Neck Surgery, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | | | - Marie Bunne
- Department of Otorhinolaryngology & Head and Neck Surgery, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Muneera Iftikhar
- Department of Otorhinolaryngology & Head and Neck Surgery, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Ralf Greisiger
- Department of Otorhinolaryngology & Head and Neck Surgery, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Leif Runar Opheim
- Department of Otorhinolaryngology & Head and Neck Surgery, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Hilde Korslund
- Interventional Centre, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Marte Myhrum
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Otorhinolaryngology & Head and Neck Surgery, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Torquil Mcdonald Sørensen
- Department of Otorhinolaryngology & Head and Neck Surgery, Oslo University Hospital, Rikshospitalet, Oslo, Norway
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22
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Auinger AB, Dahm V, Liepins R, Riss D, Baumgartner WD, Arnoldner C. Robotic Cochlear Implant Surgery: Imaging-Based Evaluation of Feasibility in Clinical Routine. Front Surg 2021; 8:742219. [PMID: 34660683 PMCID: PMC8511493 DOI: 10.3389/fsurg.2021.742219] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 08/30/2021] [Indexed: 01/10/2023] Open
Abstract
Background: Robotic surgery has been proposed in various surgical fields to reduce recovery time, scarring, and to improve patients' outcomes. Such innovations are ever-growing and have now reached the field of cochlear implantation. To implement robotic ear surgery in routine, it is of interest if preoperative planning of a safe trajectory to the middle ear is possible with clinically available image data. Methods: We evaluated the feasibility of robotic cochlear implant surgery in 50 patients (100 ears) scheduled for routine cochlear implant procedures based on clinically available imaging. The primary objective was to assess if available high-resolution computed tomography or cone beam tomography imaging is sufficient for planning a trajectory by an otological software. Secondary objectives were to assess the feasibility of cochlear implant surgery with a drill bit diameter of 1.8 mm, which is the currently used as a standard drill bit. Furthermore, it was evaluated if feasibility of robotic surgery could be increased when using smaller drill bit sizes. Cochlear and trajectory parameters of successfully planned ears were collected. Measurements were carried out by two observers and the interrater reliability was assessed using Cohen's Kappa. Results: Under the prerequisite of the available image data being sufficient for the planning of the procedure, up to two thirds of ears were eligible for robotic cochlear implant surgery with the standard drill bit size of 1.8 mm. The main reason for inability to plan the keyhole access was insufficient image resolution causing anatomical landmarks not being accurately identified. Although currently not applicable in robotic cochlear implantation, narrower drill bit sizes ranging from 1.0 to 1.7 mm in diameter could increase feasibility up to 100%. The interrater agreement between the two observers was good for this data set. Discussion: For robotic cochlear implant surgery, imaging with sufficient resolution is essential for preoperative assessment. A slice thickness of <0.3 mm is necessary for trajectory planning. This can be achieved by using digital volume tomography while radiation exposure can be kept to a minimum. Furthermore, surgeons who use the software tool, should be trained on a regular basis in order to achieve planning consistency.
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Affiliation(s)
- Alice Barbara Auinger
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - Valerie Dahm
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - Rudolfs Liepins
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - Dominik Riss
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - Wolf-Dieter Baumgartner
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - Christoph Arnoldner
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
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23
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Talon E, Visini M, Wagner F, Caversaccio M, Wimmer W. Quantitative Analysis of Temporal Bone Density and Thickness for Robotic Ear Surgery. Front Surg 2021; 8:740008. [PMID: 34660681 PMCID: PMC8514837 DOI: 10.3389/fsurg.2021.740008] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 09/06/2021] [Indexed: 11/13/2022] Open
Abstract
Background and Objective: Quantitative assessment of bone density and thickness in computed-tomography images offers great potential for preoperative planning procedures in robotic ear surgery. Methods: We retrospectively analyzed computed-tomography scans of subjects undergoing cochlear implantation (N = 39). In addition, scans of Thiel-fixated ex-vivo specimens were analyzed (N = 15). To estimate bone mineral density, quantitative computed-tomography data were obtained using a calibration phantom. The temporal bone thickness and cortical bone density were systematically assessed at retroauricular positions using an automated algorithm referenced by an anatomy-based coordinate system. Two indices are proposed to include information of bone density and thickness for the preoperative assessment of safe screw positions (Screw Implantation Safety Index, SISI) and mass distribution (Column Density Index, CODI). Linear mixed-effects models were used to assess the effects of age, gender, ear side and position on bone thickness, cortical bone density and the distribution of the indices. Results: Age, gender, and ear side only had negligible effects on temporal bone thickness and cortical bone density. The average radiodensity of cortical bone was 1,511 Hounsfield units, corresponding to a bone mineral density of 1,145 mg HA/cm3. Temporal bone thickness and cortical bone density depend on the distance from Henle's spine in posterior direction. Moreover, safe screw placement locations can be identified by computation of the SISI distribution. A local maximum in mass distribution was observed posteriorly to the supramastoid crest. Conclusions: We provide quantitative information about temporal bone density and thickness for applications in robotic and computer-assisted ear surgery. The proposed preoperative indices (SISI and CODI) can be applied to patient-specific cases to identify optimal regions with respect to bone density and thickness for safe screw placement and effective implant positioning.
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Affiliation(s)
- Emile Talon
- Hearing Research Laboratory, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland.,Department for Otolaryngology, Head and Neck Surgery, Inselspital University Hospital Bern, Bern, Switzerland
| | - Miranda Visini
- Department for Otolaryngology, Head and Neck Surgery, Inselspital University Hospital Bern, Bern, Switzerland
| | - Franca Wagner
- Department of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Marco Caversaccio
- Hearing Research Laboratory, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland.,Department for Otolaryngology, Head and Neck Surgery, Inselspital University Hospital Bern, Bern, Switzerland
| | - Wilhelm Wimmer
- Hearing Research Laboratory, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland.,Department for Otolaryngology, Head and Neck Surgery, Inselspital University Hospital Bern, Bern, Switzerland
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24
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Dhanasingh A, Swords C, Bance M, Van Rompaey V, Van de Heyning P. Cochlear Size Assessment Predicts Scala Tympani Volume and Electrode Insertion Force- Implications in Robotic Assisted Cochlear Implant Surgery. Front Surg 2021; 8:723897. [PMID: 34660676 PMCID: PMC8514755 DOI: 10.3389/fsurg.2021.723897] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 09/06/2021] [Indexed: 11/30/2022] Open
Abstract
Objectives: The primary aim was to measure the volume of the scala tympani (ST) and the length of the straight portion of the cochlear basal turn from micro-computed tomography (μCT) images. The secondary aim was to estimate the electrode insertion force based on cochlear size and insertion speed. Both of these objectives have a direct clinical relevance in robotic assisted cochlear implant (CI) surgery. Methods: The ST was segmented in thirty μCT datasets to create a three-dimensional (3D) model and calculate the ST volume. The diameter (A-value), the width (B-value), and the straight portion of the cochlear basal turn (S-value) were measured from the oblique coronal plane. Electrode insertion force was measured in ST models of two different sizes, by inserting FLEX24 (24 mm) and FLEX28 (28 mm) electrode arrays at five different speeds (0.1, 0.5, 1, 2, and 4 mm/s). Results: The mean A-, B-, and S-values measured from the 30 μCT datasets were 9.0 ± 0.5, 6.7 ± 0.4, and 6.9 mm ± 0.5, respectively. The mean ST volume was 34.2 μl ± 7 (range 23–50 μl). The ST volume increased linearly with an increase in A- and B-values (Pearson's coefficient r = 0.55 and 0.56, respectively). The A-value exhibited linear positive correlation with the B-value and S-value (Pearson's coefficient r = 0.64 and r = 0.66, respectively). In the smaller of the two ST models, insertion forces were higher across the range of insertion speeds during both array insertions, when compared to the upscaled model. Before the maximum electrode insertion depths, a trend toward lower insertion force for lower insertion speed and vice-versa was observed. Conclusion: It is important to determine pre-operative cochlear size as this seems to have an effect upon electrode insertion forces. Higher insertion forces were seen in a smaller sized ST model across two electrode array lengths, as compared to an upscaled larger model. The ST volume, which cannot be visualized on clinical CT, correlates with clinical cochlear parameters. This enabled the creation of an equation capable of predicting ST volume utilizing A- and B-values, thus enabling pre-operative prediction of ST volume.
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Affiliation(s)
- Anandhan Dhanasingh
- Research and Development Department, MED-EL, Innsbruck, Austria.,Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Chloe Swords
- Department of Physiology, Development and Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | - Manohar Bance
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | - Vincent Van Rompaey
- Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Department of Otorhinolaryngology and Head & Neck Surgery, Antwerp University Hospital, Antwerp, Belgium
| | - Paul Van de Heyning
- Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Department of Otorhinolaryngology and Head & Neck Surgery, Antwerp University Hospital, Antwerp, Belgium
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25
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Riojas KE, Tran ET, Freeman MH, Noble JH, Webster RJ, Labadie RF. Clinical Translation of an Insertion Tool for Minimally Invasive Cochlear Implant Surgery. J Med Device 2021; 15:031001. [PMID: 33995757 PMCID: PMC8086187 DOI: 10.1115/1.4050203] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 01/22/2021] [Indexed: 11/08/2022] Open
Abstract
The objective of this paper is to describe the development of a minimally invasive cochlear implant surgery (MICIS) electrode array insertion tool concept to enable clinical translation. First, analysis of the geometric parameters of potential MICIS patients (N = 97) was performed to inform tool design, inform MICIS phantom model design, and provide further insight into MICIS candidacy. Design changes were made to the insertion tool based on clinical requirements and parameter analysis results. A MICIS phantom testing model was built to evaluate insertion force profiles in a clinically realistic manner, and the new tool design was evaluated in the model and in cadavers to test clinical viability. Finally, after regulatory approval, the tool was used for the first time in a clinical case. Results of this work included first, in the parameter analysis, approximately 20% of the population was not considered viable MICIS candidates. Additionally, one 3D printed tool could accommodate all viable candidates with polyimide sheath length adjustments accounting for interpatient variation. The insertion tool design was miniaturized out of clinical necessity and a disassembly method, necessary for removal around the cochlear implant, was developed and tested. Phantom model testing revealed that the force profile of the insertion tool was similar to that of traditional forceps insertion. Cadaver testing demonstrated that all clinical requirements (including complete disassembly) were achieved with the tool, and the new tool enabled 15% deeper insertions compared to the forceps approach. Finally, and most importantly, the tool helped achieve a full insertion in its first MICIS clinical case. In conclusion, the new insertion tool provides a clinically viable solution to one of the most difficult aspects of MICIS.
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Affiliation(s)
- Katherine E. Riojas
- Department of Mechanical Engineering, Vanderbilt University, Nashville, TN 37212
| | - Emily T. Tran
- Department of Mechanical Engineering, The University of Tulsa, Tulsa, OK 74104
| | - Michael H. Freeman
- Department of Otolaryngology–Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN 37232
| | - Jack H. Noble
- Department of Electrical Engineering and Computer Science, Vanderbilt University, Nashville, TN 37212
| | - Robert J. Webster
- Department of Mechanical Engineering, Vanderbilt University, Nashville, TN 37212
| | - Robert F. Labadie
- Department of Otolaryngology–Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN 37232
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26
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Miniature parallel robot with submillimeter positioning accuracy for minimally invasive laser osteotomy. ROBOTICA 2021. [DOI: 10.1017/s0263574721000990] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
AbstractTo overcome the physical limitations of mechanical bone cutting in minimally invasive surgery, we are developing a miniature parallel robot that enables positioning of a pulsed laser with an accuracy below 0.25 mm and minimizes the required manipulation space above the target tissue. This paper presents the design, control, device characteristics, functional testing, and performance evaluation of the robot. The performance of the robot was evaluated within the scope of a path-following experiment. The required accuracy for continuous cuts was achieved and reached 0.176 mm on the test bench.
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27
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Panara K, Shahal D, Mittal R, Eshraghi AA. Robotics for Cochlear Implantation Surgery: Challenges and Opportunities. Otol Neurotol 2021; 42:e825-e835. [PMID: 33993143 DOI: 10.1097/mao.0000000000003165] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Recent advancements in robotics have set forth a growing body of evidence for the clinical application of the robotic cochlear implantation (RCI), with many potential benefits. This review aims to summarize these efforts, provide the latest developments in this exciting field, and explore the challenges associated with the clinical implementation of RCI. DATA SOURCES MEDLINE, PubMed, and EMBASE databases. STUDY SELECTION A search was conducted using the keywords "robotics otolaryngology," "robotic cochlear implant," "minimally-invasive cochlear implantation," "minimally-invasive mastoidectomy," and "percutaneous cochlear implant" with all of their synonyms. Literature selection criteria included articles published in English, and articles from 1970 to present. RESULTS The use of robotics in neurotology is a relatively new endeavor that continues to evolve. Robotics is being explored by various groups to facilitate in the various steps of cochlear implant surgery, including drilling a keyhole approach to the middle ear for implants, inner ear access, and electrode insertion into the cochlea. Initial clinical trials have successfully implanted selected subjects using robotics. CONCLUSIONS The use of robotics in cochlear implants remains in its very early stages. It is hoped that robotics will improve clinical outcomes. Although successful implants with robots are reported in the literature, there are some challenges that need to be addressed before this approach can become an acceptable option for the conventional cochlear implant surgery, such as safety, time, efficiency, and cost. However, it is hoped that further advancements in robotic technology will help in overcoming these barriers leading to successful implementation for clinical utility.
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Affiliation(s)
- Kush Panara
- Department of Otolaryngology, Cochlear Implant and Hearing Research Laboratory
| | - David Shahal
- Department of Otolaryngology, Cochlear Implant and Hearing Research Laboratory
| | - Rahul Mittal
- Department of Otolaryngology, Cochlear Implant and Hearing Research Laboratory
| | - Adrien A Eshraghi
- Department of Otolaryngology, Cochlear Implant and Hearing Research Laboratory
- Department of Neurological Surgery
- Department of Pediatrics, University of Miami, Miller School of Medicine, Miami, Florida
- Department of Biomedical Engineering, University of Miami, Coral Gables, Florida
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28
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Klopp-Dutote N, Lefranc M, Strunski V, Page C. Minimally invasive fully ROBOT-assisted cochlear implantation in humans: Preliminary results in five consecutive patients. Clin Otolaryngol 2021; 46:1326-1330. [PMID: 34310841 DOI: 10.1111/coa.13840] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 05/25/2021] [Accepted: 07/17/2021] [Indexed: 11/27/2022]
Affiliation(s)
| | - Michel Lefranc
- Neurosurgery Department, Amiens University Hospital, Amiens, France
| | - Vladimir Strunski
- ENT and Head & Neck Surgery Department, Amiens University Hospital, Amiens, France
| | - Cyril Page
- ENT and Head & Neck Surgery Department, Amiens University Hospital, Amiens, France
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29
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Riepl R, Greve J, Schild LR, Böhm F, Goldberg-Bockhorn E, Hoffmann TK, Schuler PJ. Application of a new computer-assisted robotic visualization system in cochlear implantation-Proof of concept. Int J Med Robot 2021; 17:e2301. [PMID: 34111318 DOI: 10.1002/rcs.2301] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 06/03/2021] [Accepted: 06/08/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Over the last decades conventional cochlear implant (CI) surgery has remained essentially unchanged. Nevertheless, alternative implantation techniques to further improve patient outcomes such as endaural implantation or robot-assisted surgery have been proposed in recent years. However, none of these have gained acceptance in clinical routine, thus confirming a demand for new developments. METHODS Cochlear implant surgery was performed in two mastoid bones obtained from body donors using a novel hands-free exoscope. Advantages and disadvantages of the system were evaluated. RESULTS In all cases, implantation of the electrode was feasible. The system allowed for hands-free movement and adjustment of the exoscope by the head-mounted display. Network connectivity of the system leaves room for improvement. CONCLUSION The RoboticScope is an innovative tool and can be used supportively in conventional CI surgery in the experimental setting. Although operating the device requires a certain learning curve, the usability is intuitive for every ear surgeon.
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Affiliation(s)
- Ricarda Riepl
- Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Medical Center, Ulm, Germany.,Surgical Oncology Ulm, i2SOUL Consortium, Ulm, Germany
| | - Jens Greve
- Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Medical Center, Ulm, Germany.,Surgical Oncology Ulm, i2SOUL Consortium, Ulm, Germany
| | - Leon R Schild
- Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Medical Center, Ulm, Germany.,Surgical Oncology Ulm, i2SOUL Consortium, Ulm, Germany
| | - Felix Böhm
- Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Medical Center, Ulm, Germany.,Surgical Oncology Ulm, i2SOUL Consortium, Ulm, Germany
| | - Eva Goldberg-Bockhorn
- Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Medical Center, Ulm, Germany.,Surgical Oncology Ulm, i2SOUL Consortium, Ulm, Germany
| | - Thomas K Hoffmann
- Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Medical Center, Ulm, Germany.,Surgical Oncology Ulm, i2SOUL Consortium, Ulm, Germany
| | - Patrick J Schuler
- Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Medical Center, Ulm, Germany.,Surgical Oncology Ulm, i2SOUL Consortium, Ulm, Germany
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30
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Labadie RF, Riojas K, Von Wahlde K, Mitchell J, Bruns T, Webster R, Dawant B, Fitzpatrick JM, Noble J. Clinical Implementation of Second-generation Minimally Invasive Image-guided Cochlear Implantation Surgery. Otol Neurotol 2021; 42:702-705. [PMID: 33967246 DOI: 10.1097/mao.0000000000003025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Minimally invasive, image-guided cochlear implantation (CI) surgery consists of drilling a precise tunnel from the surface of the mastoid cortex through the facial recess to target the scala tympani. In the first set of clinical trials of this technique, heat-induced facial nerve paresis (House-Brackmann II/VI) occurred on a patient on the last day of the initial trial which was scheduled to be halted secondary to a change in the regulatory requirements dictated by the 2012 the Food and Drug Administration Safety and Innovation Act requiring Investigational Device Exemption approval for previously exempted customized medical device testing. To address this adverse event, extensive changes were made to the drilling protocol; additionally, a custom insertion tool was developed. To address the Food and Drug Administration Safety and Innovation Act, an Investigational Device Exemption was submitted and, subsequently approved. Herein is described our first clinical implementation of the modified technique. PATIENT Seventy-year-old with profound, postlingual sensorineural hearing loss who had previously undergone right CI via traditional approach in 2015. INTERVENTION Minimally invasive image-guided left CI. MAIN OUTCOME MEASURE Time of intervention, final location of CI electrode array within cochlea. RESULTS Surgery took 155 minutes of which the largest components (in descending order) were soft tissue work, closure, and drilling. Full scala tympani insertion with angular insertion depth of 557 degrees of the electrode array was achieved. There were no complications, and the patient had an uneventful recovery and activation. CONCLUSIONS Minimally invasive, image-guided CI surgery is achievable and reduces the mastoid depression associated with traditional CI surgery. CLINICALTRIALSGOV INFORMATION Study NCT03101917, Microtable Microstereotactic Frame and Drill Press and Associated Method for Cochlear Implantation. LEVEL OF EVIDENCE Case Report.
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Affiliation(s)
- Robert F Labadie
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center
| | | | - Kathleen Von Wahlde
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center
| | | | | | | | - Benoit Dawant
- Department of Electrical Engineering and Computer Science, Vanderbilt University, Nashville, Tennessee
| | - J Michael Fitzpatrick
- Department of Electrical Engineering and Computer Science, Vanderbilt University, Nashville, Tennessee
| | - Jack Noble
- Department of Electrical Engineering and Computer Science, Vanderbilt University, Nashville, Tennessee
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31
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Tekin AM, Matulic M, Wuyts W, Assadi MZ, Mertens G, van Rompaey V, Li Y, van de Heyning P, Topsakal V. A New Pathogenic Variant in POU3F4 Causing Deafness Due to an Incomplete Partition of the Cochlea Paved the Way for Innovative Surgery. Genes (Basel) 2021; 12:genes12050613. [PMID: 33919129 PMCID: PMC8143104 DOI: 10.3390/genes12050613] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 04/09/2021] [Accepted: 04/11/2021] [Indexed: 12/20/2022] Open
Abstract
Incomplete partition type III (IP-III) is a relatively rare inner ear malformation that has been associated with a POU3F4 gene mutation. The IP-III anomaly is mainly characterized by incomplete separation of the modiolus of the cochlea from the internal auditory canal. We describe a 71-year-old woman with profound sensorineural hearing loss diagnosed with an IP-III of the cochlea that underwent cochlear implantation. Via targeted sequencing with a non-syndromic gene panel, we identified a heterozygous c.934G > C p. (Ala31Pro) pathogenic variant in the POU3F4 gene that has not been reported previously. IP-III of the cochlea is challenging for cochlear implant surgery for two main reasons: liquor cerebrospinalis gusher and electrode misplacement. Surgically, it may be better to opt for a shorter array because it is less likely for misplacement with the electrode in a false route. Secondly, the surgeon has to consider the insertion angles of cochlear access very strictly to avoid misplacement along the inner ear canal. Genetic results in well describes genotype-phenotype correlations are a strong clinical tool and as in this case guided surgical planning and robotic execution.
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Affiliation(s)
- Ahmet M. Tekin
- Department of Otorhinolaryngology, Head and Neck Surgery, Brussels Health Campus, Vrije Universiteit Brussel, 1090 Brussels, Belgium; (A.M.T.); (M.M.)
| | - Marco Matulic
- Department of Otorhinolaryngology, Head and Neck Surgery, Brussels Health Campus, Vrije Universiteit Brussel, 1090 Brussels, Belgium; (A.M.T.); (M.M.)
| | - Wim Wuyts
- Center of Medical Genetics, Faculty of Medicine and Health Sciences, University of Antwerp and Antwerp University Hospital, 2650 Antwerp, Belgium;
| | | | - Griet Mertens
- Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, 2650 Edegem, Belgium; (G.M.); (V.v.R.); (P.v.d.H.)
- Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Antwerp, Belgium
| | - Vincent van Rompaey
- Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, 2650 Edegem, Belgium; (G.M.); (V.v.R.); (P.v.d.H.)
- Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Antwerp, Belgium
| | - Yongxin Li
- Department of Otolaryngology, Head and Neck Surgery, Capital Medical University, Beijing 100730, China;
| | - Paul van de Heyning
- Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, 2650 Edegem, Belgium; (G.M.); (V.v.R.); (P.v.d.H.)
- Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Antwerp, Belgium
| | - Vedat Topsakal
- Department of Otorhinolaryngology, Head and Neck Surgery, Brussels Health Campus, Vrije Universiteit Brussel, 1090 Brussels, Belgium; (A.M.T.); (M.M.)
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital UZ Brussel, Brussels Health Campus, Vrije Universiteit Brussel, 1090 Brussels, Belgium
- Correspondence: ; Tel.: +32-24776882; Fax: +32-24776880
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32
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Minimally Invasive Cochlear Implantation Assisted by Intraoperative CT Scan Combined to Neuronavigation. Otol Neurotol 2021; 41:e441-e448. [PMID: 32176128 DOI: 10.1097/mao.0000000000002577] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The objective of this work was to study the feasibility of minimally invasive cochlear implantation under intraoperative computerized tomography-scan coupled to navigation. MATERIALS AND METHODS Five human resin temporal bones (two adults and three children) were used. Initially, a temporal bone imaging was obtained by the intraoperative CT-scan coupled to the navigation (O-ARM). The navigation-assisted drilling began at the mastoid surface creating a conical tunnel (4-2 mm in diameter) through the facial recess and down to the round window. A cochleostomy was performed based on the navigation. A sham electrode array was inserted in the drilled tunnel and into the cochlea.Postoperative CT-scan and dissection were performed to evaluate the trajectory, and possible injury to the external auditory canal, ossicles, or facial nerve. RESULTS The mean duration of the procedure was 24.4 ± 3.79 minutes (range, 15-35). Cochleostomy was possible in all cases without injury to other structures. The sham array was inside the cochlea in all cases. The mean distance between the drilled canal and the mastoid portion of the facial nerve was 1.2 ± 0.07 mm (range, 1.08-1.38). The mean tracking error was 0.6 ± 0.26 mm (range, 0.20-0.72) at the entry point, 0.6 ± 0.33 mm (range, 0.2-1.02) at the facial nerve and 0.4 ± 0.07 mm (range, 0.36-0.51) at the cochleostomy. CONCLUSION Cochlear implantation through a minimally invasive approach assisted by intraoperative imaging combined with navigation was feasible in operating room environment and experimental conditions.
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33
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Dai Y, Xue Y, Zhang J. Human-Inspired Haptic Perception and Control in Robot-Assisted Milling Surgery. IEEE TRANSACTIONS ON HAPTICS 2021; 14:359-370. [PMID: 33044941 DOI: 10.1109/toh.2020.3029043] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Bone milling is one of the most widely used and high-risk procedures in various types of surgeries, and it is important to be noted that the experienced surgeon can perform such an operation safely. The objective of this article is to enhance the safety of the robot-assisted milling operation with the inspiration of human haptic perception. The emergence, coding and perception of the human haptic are introduced. Following this, a single axis accelerometer that measures the vibration of the surgical power tool is mounted in the robot arm, and the recorded acceleration signal is encoded as parallel stream of binary data. The data are subsequently inputted to the Hopfield network so as to identify the milling state. Inspired by human inference procedure, the fuzzy logic controller is introduced to control the robot to track the desired state when performing bone milling operations. A real-time implementation of the proposed method on a digital signal processing is also described. The experimental results in milling porcine spines prove that the robot accurately discriminates different milling states even when the additive noise is serious, and the safe motion control of the robot is also realized.
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Precision head and neck surgery: robotics and surgical vision technology. Curr Opin Otolaryngol Head Neck Surg 2021; 29:161-167. [PMID: 33664199 DOI: 10.1097/moo.0000000000000706] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
PURPOSE OF REVIEW As the molecular basis of head and neck cancer becomes more clearly defined, precision medicine has gradually refined the multidisciplinary treatment paradigm for patients with oropharyngeal cancer. Although precision medicine is often thought to refer to new molecular diagnostics or unique medical therapy, the recent adoption of robotic surgery has ushered in the era of 'precision' head and neck surgery. RECENT FINDINGS Surgeons now routinely utilize a virtual reality environment to reduce the morbidity of head and neck surgical care and improve oncologic and functional outcomes. The development and subsequent FDA approval of the da Vinci SP system, a single-arm system with a flexible camera, has allowed for improved visualization and access to the deep oropharynx and larynx. Groups investigating anti-EGFR antibodies tagged with fluorescent dye as well as inherent autofluorescence differences between normal and cancerous mucosal tissues show promise for improving positive surgical margin rates. SUMMARY The evolution of robotics and visualization for oropharyngeal cancer represents a novel and innovative utilization of new technology to improve care. Further advancements in techniques, from refinement of the robotic platform itself, to novel real-time tumour imaging options will be critical to further advance precision care for these patients.
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Hochmair I. Translational research around five categories of CI. Acta Otolaryngol 2021; 141:178-184. [PMID: 33818266 DOI: 10.1080/00016489.2021.1888516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Five categories of cochlear implants are introduced: The 'classic CI', the 'combined CI' - which can be combining a CI based on electric stimulation with acoustic stimulation (EAS) or with mechanical stimulation (EMS) or with electrical stimulation of the vestibular system (VICI) -, the 'individualised CI', the 'augmented CI' and the 'totally implantable CI'. The translational research activities leading to and within these categories have been, are and will be numerous and are the subject of the compendium for which this paper is the concluding chapter. Early translational research has resulted in the 'classic CI' in 1994. From then on translational research enabled the developments respectively the new indications and reimbursement of CI-systems for bilateral CIs, CI in single sided deafness, the auditory brainstem implant, speech coding and signal processing advances, electrophysiologic measurements for evaluation of cochlear health, all within the classic CI category. Starting points for the four newer categories of CI are either ideas of professionals treating hearing loss or of CI developers. The translational research performed also triggered research that led and leads to improved understanding of the fundamental mechanisms of hearing.
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Affiliation(s)
- Ingeborg Hochmair
- MED-EL Elektromedizinische Geraete Gesellschaft m.b.H., Innsbruck, Austria
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Copson B, Wijewickrema S, Ma X, Zhou Y, Gerard JM, O'Leary S. Surgical approach to the facial recess influences the acceptable trajectory of cochlear implantation electrodes. Eur Arch Otorhinolaryngol 2021; 279:137-147. [PMID: 33547488 DOI: 10.1007/s00405-021-06633-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 01/20/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE To provide practical guidance to the operative surgeon by mapping the location, where acceptable straight-line virtual cochlear implant electrode trajectories intersect the facial recess. In addition, to investigate the influence of facial recess preparation, virtual electrode width and surgical approach to the cochlea on these available trajectories. METHODS The study was performed on imaging data from eight cadaveric temporal bones within the University of Melbourne Virtual Reality (VR) Temporal Bone Surgery Simulator. The facial recess was opened to varying degrees, and acceptable trajectory vectors with varying diameters were calculated for electrode insertions via cochleostomy or round window membrane (RWM). The percentage of acceptable insertion vectors through each location of the facial recess was visually represented using heatmaps. RESULTS Seven of the eight bones allowed for acceptable vector trajectories via both cochleostomy and RWM approaches. These acceptable trajectories were more likely to lie superiorly within the facial recess for insertion via the round window, and inferiorly for insertion via cochleostomy. Cochleostomy insertions required a greater degree of preparation and skeletonisation of the junction of the facial nerve and chorda tympani within the facial recess. The width of the virtual electrode had only marginal impact on the availability of acceptable trajectories. Heatmaps emphasised the intimate relationship the acceptable trajectories have with the facial nerve and chorda tympani. CONCLUSION These findings highlight the differences in the acceptable straight-line trajectories for electrodes when implanted via the round window or cochleostomy. There were notable exceptions to both surgical approaches, likely explained by the variation of hook region anatomy. The methodology used in this study holds promise for translation to patient specific surgical planning.
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Affiliation(s)
- Bridget Copson
- Department of Surgery (Otolaryngology), University of Melbourne, Level 5, Royal Victorian Eye and Ear Hospital, 32, Gisborne Street, East Melbourne, VIC, 3002, Australia.
| | - Sudanthi Wijewickrema
- Department of Surgery (Otolaryngology), University of Melbourne, Level 5, Royal Victorian Eye and Ear Hospital, 32, Gisborne Street, East Melbourne, VIC, 3002, Australia
| | - Xingjun Ma
- Department of Surgery (Otolaryngology), University of Melbourne, Level 5, Royal Victorian Eye and Ear Hospital, 32, Gisborne Street, East Melbourne, VIC, 3002, Australia
| | - Yun Zhou
- Department of Surgery (Otolaryngology), University of Melbourne, Level 5, Royal Victorian Eye and Ear Hospital, 32, Gisborne Street, East Melbourne, VIC, 3002, Australia
| | - Jean-Marc Gerard
- Department of Surgery (Otolaryngology), University of Melbourne, Level 5, Royal Victorian Eye and Ear Hospital, 32, Gisborne Street, East Melbourne, VIC, 3002, Australia
| | - Stephen O'Leary
- Department of Surgery (Otolaryngology), University of Melbourne, Level 5, Royal Victorian Eye and Ear Hospital, 32, Gisborne Street, East Melbourne, VIC, 3002, Australia
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Chiluisa AJ, Van Rossum FJ, Gafford JB, Labadie RF, Webster RJ, Fichera L. Computational Optimization of Notch Spacing for a Transnasal Ear Endoscopy Continuum Robot. ... INTERNATIONAL SYMPOSIUM ON MEDICAL ROBOTICS. INTERNATIONAL SYMPOSIUM ON MEDICAL ROBOTICS 2020; 2020:188-194. [PMID: 36844884 PMCID: PMC9948123 DOI: 10.1109/ismr48331.2020.9312937] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
This paper presents a computational framework to optimize the visual coverage attainable by a notched-tube continuum robotic endoscope inside the middle ear cavity. Our framework combines anatomically-accurate geometric (mesh) models of the middle ear with a sampling-based motion planning algorithm (RRT) and a ray-casting procedure to quantify what regions of the middle ear can be accessed and visualized by the endoscope. To demonstrate the use of this framework, we run computer simulations to investigate the effect of varying the distance between each pair of consecutive flexure elements (i.e., notches) in our robotic endoscope.
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Affiliation(s)
- Alex J Chiluisa
- Robotics Engineering Program, Worcester Polytechnic Institute, Worcester, MA 01609, USA
| | - Floris J Van Rossum
- Robotics Engineering Program, Worcester Polytechnic Institute, Worcester, MA 01609, USA
| | - Joshua B Gafford
- Department of Mechanical Engineering, Vanderbilt University, Nashville, TN 37212, USA
| | - Robert F Labadie
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, TN, 37235, USA
| | - Robert J Webster
- Department of Mechanical Engineering, Vanderbilt University, Nashville, TN 37212, USA
| | - Loris Fichera
- Robotics Engineering Program, Worcester Polytechnic Institute, Worcester, MA 01609, USA
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Wang J, Liu H, Ke J, Hu L, Zhang S, Yang B, Sun S, Guo N, Ma F. Image-guided cochlear access by non-invasive registration: a cadaveric feasibility study. Sci Rep 2020; 10:18318. [PMID: 33110188 PMCID: PMC7591497 DOI: 10.1038/s41598-020-75530-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 10/15/2020] [Indexed: 11/09/2022] Open
Abstract
Image-guided cochlear implant surgery is expected to reduce volume of mastoidectomy, accelerate recovery, and improve safety. The purpose of this study was to investigate the safety and effectiveness of image-guided cochlear implant surgery by a non-invasive registration method, in a cadaveric study. We developed a visual positioning frame that can utilize the maxillary dentition as a registration tool and completed the tunnels experiment on 5 cadaver specimens (8 cases in total). The accuracy of the entry point and the target point were 0.471 ± 0.276 mm and 0.671 ± 0.268 mm, respectively. The shortest distance from the margin of the tunnel to the facial nerve and the ossicular chain were 0.790 ± 0.709 mm and 1.960 ± 0.630 mm, respectively. All facial nerves, tympanic membranes, and ossicular chains were completely preserved. Using this approach, high accuracy was achieved in this preliminary study, suggesting that the non-invasive registration method can meet the accuracy requirements for cochlear implant surgery. Based on the above accuracy, we speculate that our method can also be applied to neurosurgery, orbitofacial surgery, lateral skull base surgery, and anterior skull base surgery with satisfactory accuracy.
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Affiliation(s)
- Jiang Wang
- Department of Otorhinolaryngology - Head and Neck Surgery, Peking University Third Hospital, Peking University, No. 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Hongsheng Liu
- The Robotics Institute, School of Mechanical Engineering and Automation, Beihang University, Beijing, China
| | - Jia Ke
- Department of Otorhinolaryngology - Head and Neck Surgery, Peking University Third Hospital, Peking University, No. 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Lei Hu
- The Robotics Institute, School of Mechanical Engineering and Automation, Beihang University, Beijing, China
| | - Shaoxing Zhang
- Department of Otorhinolaryngology - Head and Neck Surgery, Peking University Third Hospital, Peking University, No. 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Biao Yang
- The Robotics Institute, School of Mechanical Engineering and Automation, Beihang University, Beijing, China
| | - Shilong Sun
- Department of Otorhinolaryngology - Head and Neck Surgery, Peking University Third Hospital, Peking University, No. 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Na Guo
- The Robotics Institute, School of Mechanical Engineering and Automation, Beihang University, Beijing, China
| | - Furong Ma
- Department of Otorhinolaryngology - Head and Neck Surgery, Peking University Third Hospital, Peking University, No. 49 North Garden Road, Haidian District, Beijing, 100191, China.
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Jank BJ, Haas M, Riss D, Baumgartner WD. Acceptance of patients towards task-autonomous robotic cochlear implantation: An exploratory study. Int J Med Robot 2020; 17:1-6. [PMID: 32949426 PMCID: PMC7900970 DOI: 10.1002/rcs.2172] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 09/08/2020] [Accepted: 09/17/2020] [Indexed: 01/03/2023]
Abstract
Background Recently, task‐autonomous image‐guided robotic cochlear implantation has been successfully completed in patients. However, no data exist on patients' perspective of this new technology. The aim of this study was to evaluate the acceptance of patients towards task‐autonomous robotic cochlear implantation (TARCI). Methods We prospectively surveyed 63 subjects (51 patients and 12 parents of infants) scheduled for manual cochlear implantation. We collected sociodemographic and clinico‐pathological characteristics and their attitude towards TARCI for themselves or their child using a questionnaire. Differences between variables were analysed using one‐way analysis of variance and Spearman's rho was used to test for correlation. Results Seventy‐three percent of patients and 84% of parents expressed a high acceptance towards TARCI for themselves, or their child, respectively. Interestingly, patients with a negative attitude towards TARCI were significantly younger. Conclusion The attitude of patients and parents likely does not represent a barrier towards application of this new technology.
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Affiliation(s)
- Bernhard J Jank
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - Markus Haas
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - Dominik Riss
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - Wolf-Dieter Baumgartner
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
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BAYRAM A, ESKİİZMİR G, CİNGİ C, HANNA E. Robotic Surgery in Otolaryngology-Head and Neck Surgery: Yesterday, Today and Tomorrow. ENT UPDATES 2020. [DOI: 10.32448/entupdates.780604] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Lucidi D, Fernandez IJ, Martone A, Molinari G, Bonali M, Villari D, Alicandri-Ciufelli M, Presutti L. Use of IMAGE1 S technology for detection of cholesteatoma in endoscopic ear surgery: a retrospective case series on 45 patients. Eur Arch Otorhinolaryngol 2020; 278:1373-1380. [PMID: 32666292 DOI: 10.1007/s00405-020-06204-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 07/08/2020] [Indexed: 12/31/2022]
Abstract
PURPOSE To evaluate the role of selected modalities of Storz Professional Image Enhancement System (IMAGE1 S) in differentiating cholesteatoma during endoscopic ear surgery (EES); to assess the potential usefulness of IMAGE1 S in recognition of cholesteatoma residuals at the end of EES. METHODS A retrospective study on 45 consecutive patients who underwent EES for cholesteatoma between March 2019 and November 2019 at a tertiary referral center was performed. For each case, Spectra A and Spectra B filters were applied intra-operatively. When examining the surgical field, a switch from white light (WL) to IMAGE1 S was performed to detect cholesteatoma and differentiate it from non-cholesteatomatous tissue. When the IMAGE1 S pattern was suspicious for the presence of cholesteatoma, images of the field under both enhancement modalities were taken and the targeted lesions were sent for histologic analysis. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of IMAGE1 S were calculated. A final recognition of the surgical field using the selected filters was performed to detect any possible cholesteatomatous residuals. RESULTS Detection of cholesteatoma by IMAGE1 S selected filters revealed the following data: sensitivity 97%, specificity 95%, PPV 95%, NPV 97%. On three occasions, there was no correspondence between enhanced endoscopy and histology. In 5 out of 45 cases (11%), cholesteatoma residuals, which had not been identified at WL inspection at the end of the procedure, were detected by IMAGE1 S. CONCLUSION Our results suggest a potential role for IMAGE1 S Spectra A and B filters in EES for cholesteatoma surgery. We propose the integration of IMAGE1 S as a final overview of the surgical cavity for recognition of cholesteatomatous residuals.
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Affiliation(s)
- Daniela Lucidi
- Department of Otolaryngology - Head and Neck Surgery, University Hospital of Modena, Largo del Pozzo, 71, 41125, Modena, Italy.
| | - Ignacio Javier Fernandez
- Department of Otolaryngology - Head and Neck Surgery, University Hospital of Modena, Largo del Pozzo, 71, 41125, Modena, Italy
| | - Andrea Martone
- Department of Otolaryngology - Head and Neck Surgery, University Hospital of Modena, Largo del Pozzo, 71, 41125, Modena, Italy
| | - Giulia Molinari
- Department of Otolaryngology - Head and Neck Surgery, University Hospital of Modena, Largo del Pozzo, 71, 41125, Modena, Italy
| | - Marco Bonali
- Department of Otolaryngology - Head and Neck Surgery, University Hospital of Modena, Largo del Pozzo, 71, 41125, Modena, Italy
| | - Domenico Villari
- Department of Otolaryngology - Head and Neck Surgery, University Hospital of Modena, Largo del Pozzo, 71, 41125, Modena, Italy
| | - Matteo Alicandri-Ciufelli
- Department of Otolaryngology - Head and Neck Surgery, University Hospital of Modena, Largo del Pozzo, 71, 41125, Modena, Italy
| | - Livio Presutti
- Department of Otolaryngology - Head and Neck Surgery, University Hospital of Modena, Largo del Pozzo, 71, 41125, Modena, Italy
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Noise Exposure on Human Cochlea During Cochleostomy Formation Using Conventional and a Hand Guided Robotic Drill. Otol Neurotol 2020; 41:e829-e835. [PMID: 32558760 DOI: 10.1097/mao.0000000000002699] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate the disturbance induced in the cochlea during cochleostomy using conventional drill and a hand guided robotic drill. STUDY DESIGN The study is based on experimental measurements using the Laser Doppler Vibrometer during the drilling processes converted to Sound Pressure Levels (SPL) for comparison. SETTING The study is based on experimental results of three sets of cochleostomies on human cadaver heads. MAIN OUTCOME MEASURE(S) Robotic drilling, in comparison to the conventional drilling method, creates a consistently lower level of disturbance in cochlea across the hearing frequency range. RESULTS Robotic drilling, in comparison to the conventional drilling method, creates a consistently lower level of disturbance in cochlea across the hearing frequency range. CONCLUSIONS It is reasonable to conclude that robotic drilling has a lower possibility of creating acoustic trauma in cochlea that endangers the residual hearing of patients.
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Baumann U, Stöver T, Weißgerber T. Device profile of the MED-EL cochlear implant system for hearing loss: overview of its safety and efficacy. Expert Rev Med Devices 2020; 17:599-614. [PMID: 32552086 DOI: 10.1080/17434440.2020.1781614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Patients suffering from severe to profound hearing loss or even deafness can achieve a hearing improvement with a cochlear implant (CI) treatment that is significantly higher than the results achieved with conventional hearing aids. The CI system consists of an implantable stimulator, which is inserted retro-auricularly into the mastoid, and an externally worn processor unit, which provides the pickup of sound and processing of acoustic information as well as the power supply for the stimulator and internal current sources. The stimulator has an electrode array that is inserted into the cochlea. AREAS COVERED This is a descriptive overview of MED-EL's multichannel CI system (MED-EL, Innsbruck, Austria), which was introduced to the European market in 1994. The continuing development of the implant as well as the external components is outlined and various other aspects (stimulation strategy, adaptation, results, reliability) are discussed. EXPERT COMMENTARY The strength of the company is the continuous pursuit of innovative ideas. This is evidenced by numerous innovations. The reliability of the implants has been continuously improved. The current SYNCHRONY models of the manufacturer show no indication of technically caused failures over an observation period of 5 years.
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Affiliation(s)
- Uwe Baumann
- Audiological Acoustics, ENT Department, University Hospital Frankfurt , Frankfurt Am Main, Germany
| | - Timo Stöver
- ENT Department, University Hospital Frankfurt , Frankfurt Am Main, Germany
| | - Tobias Weißgerber
- Audiological Acoustics, ENT Department, University Hospital Frankfurt , Frankfurt Am Main, Germany
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Kügler D, Sehring J, Stefanov A, Stenin I, Kristin J, Klenzner T, Schipper J, Mukhopadhyay A. i3PosNet: instrument pose estimation from X-ray in temporal bone surgery. Int J Comput Assist Radiol Surg 2020; 15:1137-1145. [PMID: 32440956 PMCID: PMC7316684 DOI: 10.1007/s11548-020-02157-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 04/03/2020] [Indexed: 11/03/2022]
Abstract
PURPOSE Accurate estimation of the position and orientation (pose) of surgical instruments is crucial for delicate minimally invasive temporal bone surgery. Current techniques lack in accuracy and/or line-of-sight constraints (conventional tracking systems) or expose the patient to prohibitive ionizing radiation (intra-operative CT). A possible solution is to capture the instrument with a c-arm at irregular intervals and recover the pose from the image. METHODS i3PosNet infers the position and orientation of instruments from images using a pose estimation network. Said framework considers localized patches and outputs pseudo-landmarks. The pose is reconstructed from pseudo-landmarks by geometric considerations. RESULTS We show i3PosNet reaches errors [Formula: see text] mm. It outperforms conventional image registration-based approaches reducing average and maximum errors by at least two thirds. i3PosNet trained on synthetic images generalizes to real X-rays without any further adaptation. CONCLUSION The translation of deep learning-based methods to surgical applications is difficult, because large representative datasets for training and testing are not available. This work empirically shows sub-millimeter pose estimation trained solely based on synthetic training data.
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Affiliation(s)
- David Kügler
- Department of Computer Science, Technischer Universität Darmstadt, Darmstadt, Germany. .,German Center for Degenerative Diseases (DZNE) e.V., Bonn, Germany.
| | - Jannik Sehring
- Department of Computer Science, Technischer Universität Darmstadt, Darmstadt, Germany
| | - Andrei Stefanov
- Department of Computer Science, Technischer Universität Darmstadt, Darmstadt, Germany
| | - Igor Stenin
- ENT Clinic, University Düsseldorf, Düsseldorf, Germany
| | - Julia Kristin
- ENT Clinic, University Düsseldorf, Düsseldorf, Germany
| | | | - Jörg Schipper
- ENT Clinic, University Düsseldorf, Düsseldorf, Germany
| | - Anirban Mukhopadhyay
- Department of Computer Science, Technischer Universität Darmstadt, Darmstadt, Germany
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Liu R, Tan Z, Li J, Yan Y, Ren W, Zhang M, Yang S, Zhao H. Improvements to the retractor and muscle flap design for minimally invasive cochlear implantation. J Otol 2020; 15:41-44. [PMID: 32110240 PMCID: PMC7033583 DOI: 10.1016/j.joto.2019.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Revised: 09/07/2019] [Accepted: 09/12/2019] [Indexed: 11/03/2022] Open
Abstract
Objective The aim of this study was to improve muscle flaps and to evaluate surgical outcomes with the use of a novel specialized retractor, which is a surgical instrument used to locate and shape a bony seat for minimally invasive cochlear implantation. Methods 50 patients aged 1-75 years with sensorineural hearing loss who required cochlear implantation were recruited. A small incision (<3 cm) was made, and the novel specialized retractor was used in the study group during cochlear implantation. The incision length, surgical outcomes and operative time were recorded and analyzed. Results The incision length, total operative time and drilling bony time were shorter in the study group than in the control group (P < 0.05, respectively). All patients recovered well after the surgery without any severe complications. Conclusion The use of a novel specialized retractor standardized the surgical processes of cochlear implantation. The retractor helped locate and control the size of the bony well during bone drilling. The tool reduced the technical difficulty and improved the efficacy of this minimally invasive operation.
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Affiliation(s)
- Riyuan Liu
- Department of Otolaryngology Head and Neck Surgery, Institute of Otolaryngology, Chinese PLA General Hospital, China National Clinical Research Center for Otolaryngologic Diseases, Beijing, 100853, China
| | - Zhiping Tan
- Zhejiang Nurotron Biotechnology Company Limited, Hangzhou, Zhejiang, 311121, China
| | - Jianan Li
- Department of Otolaryngology Head and Neck Surgery, Institute of Otolaryngology, Chinese PLA General Hospital, China National Clinical Research Center for Otolaryngologic Diseases, Beijing, 100853, China
| | - Yan Yan
- Department of Otolaryngology Head and Neck Surgery, Institute of Otolaryngology, Chinese PLA General Hospital, China National Clinical Research Center for Otolaryngologic Diseases, Beijing, 100853, China
| | - Wei Ren
- Department of Otolaryngology Head and Neck Surgery, Institute of Otolaryngology, Chinese PLA General Hospital, China National Clinical Research Center for Otolaryngologic Diseases, Beijing, 100853, China
| | - Miao Zhang
- Department of Otolaryngology Head and Neck Surgery, Institute of Otolaryngology, Chinese PLA General Hospital, China National Clinical Research Center for Otolaryngologic Diseases, Beijing, 100853, China
| | - Shiming Yang
- Department of Otolaryngology Head and Neck Surgery, Institute of Otolaryngology, Chinese PLA General Hospital, China National Clinical Research Center for Otolaryngologic Diseases, Beijing, 100853, China
| | - Hui Zhao
- Department of Otolaryngology Head and Neck Surgery, Institute of Otolaryngology, Chinese PLA General Hospital, China National Clinical Research Center for Otolaryngologic Diseases, Beijing, 100853, China
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Bruns TL, Riojas KE, Ropella DS, Cavilla MS, Petruska AJ, Freeman MH, Labadie RF, Abbott JJ, Webster RJ. Magnetically Steered Robotic Insertion of Cochlear-Implant Electrode Arrays: System Integration and First-In-Cadaver Results. IEEE Robot Autom Lett 2020; 5:2240-2247. [PMID: 34621979 DOI: 10.1109/lra.2020.2970978] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Cochlear-implant electrode arrays (EAs) must be inserted accurately and precisely to avoid damaging the delicate anatomical structures of the inner ear. It has previously been shown on the benchtop that using magnetic fields to steer magnet-tipped EAs during insertion reduces insertion forces, which correlate with insertion errors and damage to internal cochlear structures. This paper presents several advancements toward the goal of deploying magnetic steering of cochlear-implant EAs in the operating room. In particular, we integrate image guidance with patient-specific insertion vectors, we incorporate a new nonmagnetic insertion tool, and we use an electromagnetic source, which provides programmable control over the generated field. The electromagnet is safer than prior permanent-magnet approaches in two ways: it eliminates motion of the field source relative to the patient's head and creates a field-free source in the power-off state. Using this system, we demonstrate system feasibility by magnetically steering EAs into a cadaver cochlea for the first time. We show that magnetic steering decreases average insertion forces, in comparison to manual insertions and to image-guided robotic insertions alone.
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Affiliation(s)
- Trevor L Bruns
- Department of Mechanical Engineering, Vanderbilt University, Nashville, TN, USA
| | - Katherine E Riojas
- Department of Mechanical Engineering, Vanderbilt University, Nashville, TN, USA
| | - Dominick S Ropella
- Department of Mechanical Engineering, Vanderbilt University, Nashville, TN, USA
| | - Matt S Cavilla
- Department of Mechanical Engineering, University of Utah, Salt Lake City, UT, USA
| | - Andrew J Petruska
- Department of Mechanical Engineering, Colorado School of Mines, Golden, CO, USA
| | - Michael H Freeman
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Robert F Labadie
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jake J Abbott
- Department of Mechanical Engineering, University of Utah, Salt Lake City, UT, USA
| | - Robert J Webster
- Department of Mechanical Engineering, Vanderbilt University, Nashville, TN, USA
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Wimmer W, Anschuetz L, Weder S, Wagner F, Delingette H, Caversaccio M. Human bony labyrinth dataset: Co-registered CT and micro-CT images, surface models and anatomical landmarks. Data Brief 2019; 27:104782. [PMID: 31763421 PMCID: PMC6864122 DOI: 10.1016/j.dib.2019.104782] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 10/30/2019] [Accepted: 11/01/2019] [Indexed: 12/24/2022] Open
Abstract
The presented data set consists of images, labels and surface models of 23 human bony labyrinths. For each specimen clinical computed tomography (CT) and co-registered high-resolution micro-CT images were acquired. Using the images, the bony labyrinth was segmented and 3D surface models were generated. Each specimen is accompanied by a description file containing the coordinates of anatomical landmarks and the corresponding cochlear coordinate system. The data set can be used to study the morphology of the inner ear or to evaluate segmentation algorithm as used for the preoperative planning of surgical procedures such as cochlear implantation.
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Affiliation(s)
- Wilhelm Wimmer
- Department of ENT, Head and Neck Surgery, Inselspital, Bern University Hospital, Switzerland
- Hearing Research Laboratory, ARTORG Center for Biomedical Engineering Research, University of Bern, Switzerland
- Université Côte d’Azur, Inria, Epione, Sophia Antipolis, France
| | - Lukas Anschuetz
- Department of ENT, Head and Neck Surgery, Inselspital, Bern University Hospital, Switzerland
| | - Stefan Weder
- Department of ENT, Head and Neck Surgery, Inselspital, Bern University Hospital, Switzerland
| | - Franca Wagner
- Department of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, Switzerland
| | | | - Marco Caversaccio
- Department of ENT, Head and Neck Surgery, Inselspital, Bern University Hospital, Switzerland
- Hearing Research Laboratory, ARTORG Center for Biomedical Engineering Research, University of Bern, Switzerland
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Abstract
The field of robotic surgery has progressed from small teams of researchers repurposing industrial robots, to a competitive and highly innovative subsection of the medical device industry. Surgical robots allow surgeons to perform tasks with greater ease, accuracy, or safety, and fall under one of four levels of autonomy; active, semi-active, passive, and remote manipulator. The increased accuracy afforded by surgical robots has allowed for cementless hip arthroplasty, improved postoperative alignment following knee arthroplasty, and reduced duration of intraoperative fluoroscopy among other benefits. Cutting of bone has historically used tools such as hand saws and drills, with other elaborate cutting tools now used routinely to remodel bone. Improvements in cutting accuracy and additional options for safety and monitoring during surgery give robotic surgeries some advantages over conventional techniques. This article aims to provide an overview of current robots and tools with a common target tissue of bone, proposes a new process for defining the level of autonomy for a surgical robot, and examines future directions in robotic surgery.
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