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Koutná S, Kalitová P, Jeřábek J, Slabý K, Kučerová K, Bouček J, Čakrt O. Comparison of postural control and space perception outcomes between robotic and conventional cochlear implantation in adults. Eur Arch Otorhinolaryngol 2024; 281:3839-3843. [PMID: 38825603 DOI: 10.1007/s00405-024-08664-3] [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] [Received: 02/20/2024] [Accepted: 04/06/2024] [Indexed: 06/04/2024]
Abstract
PURPOSE The aim of the study is to capture the difference between the groups in direct relation to the type of electrode array insertion during cochlear implantation (CI). The robotic insertion is expected to be a more gently option. As recent studies have shown, there is a difference in perception of visual vertical (SVV) and postural control related to the CI. We assume that there can be differences in postural control and space perception outcomes depending on the type of the surgical method. METHODS In total, 37 (24 females, mean age ± SD was 42.9 ± 13.0) candidates for CI underwent an assessment. In 14 cases, the insertion of the electrode array was performed by a robotic system (RobOtol, Colin, France) and 23 were performed conventionally. In all of these patients, we performed the same examination before the surgery, the first day, and 3 weeks after the surgery. The protocol consists of static posturography and perception of visual vertical. RESULTS The both groups, RobOtol and conventional, responded to the procedure similarly despite the dissimilar electrode insertion. There was no difference between two groups in the dynamic of perception SVV and postural parameters. Patients in both groups were statistically significantly affected by the surgical procedure, SVV deviation appeared in the opposite direction from the implanted ear: 0.90° ± 1.25; - 1.67° ± 3.05 and - 0.19° ± 1.78 PRE and POST surgery (p < 0.001). And this deviation was spontaneously adjusted in FOLLOW-UP after 3 weeks (p < 0.01) in the both groups. We did not find a significant difference in postural parameters between the RobOtol and conventional group, even over time. CONCLUSION Although the robotic system RobOtol allows a substantial reduction in the speed of insertion of the electrode array into the inner ear, our data did not demonstrate a postoperative effect on vestibular functions (SVV and posturography), which have the same character and dynamics as in the group with standard manual insertion. REGISTRATION NUMBER The project is registered on clinicaltrials.gov (registration number: NCT05547113).
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Affiliation(s)
- Sára Koutná
- Department of Rehabilitation and Sport Medicine, 2nd Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic.
| | - Petra Kalitová
- Department of Otorhinolaryngology, Head and Neck Surgery, 1st Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Jaroslav Jeřábek
- Department of Neurology, 2nd Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Kryštof Slabý
- Department of Rehabilitation and Sport Medicine, 2nd Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Klára Kučerová
- Department of Rehabilitation and Sport Medicine, 2nd Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Jan Bouček
- Department of Otorhinolaryngology, Head and Neck Surgery, 1st Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Ondřej Čakrt
- Department of Rehabilitation and Sport Medicine, 2nd Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
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Garcia A, Shave S, Cheng YS, Santos F, Quesnel A, Cohen MS, Lee DJ. Initial Experience With Robotic-Assisted Otologic and Lateral Skull Base Surgery. Otolaryngol Head Neck Surg 2024; 170:1190-1194. [PMID: 38230445 DOI: 10.1002/ohn.571] [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: 08/28/2023] [Accepted: 09/23/2023] [Indexed: 01/18/2024]
Abstract
Robotic-assisted surgery has gained popularity for otolaryngology procedures. It provides high-definition images and surgical precision to perform diverse procedures. It is an alternative to the operating microscope, endoscope, or exoscope when reaching hidden anatomical structures in the ear. In this proof-of-concept study, we aim to demonstrate the possibility of using a robotic-assisted device to perform ear surgery in conjunction with the microscope or the endoscope. In total, there were 9 ear and lateral skull base procedures performed with the use of robotic-assisted surgery. All surgeons underwent surveys to assess the performance and workload of the device compared to the microscope or endoscope. There were no postoperative complications. Robotic-assisted surgery was optimal for providing high image quality, ergonomics, and maintaining surgical performance. The size of the device and mental demand were higher compared to the microscope or endoscope. Robotic-assisted surgery can be an adjuvant to perform otologic and neurotologic surgery.
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Affiliation(s)
- Alejandro Garcia
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary (MEEI), Harvard Medical School, Boston, Massachusetts, USA
| | - Samantha Shave
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary (MEEI), Harvard Medical School, Boston, Massachusetts, USA
| | - Yew S Cheng
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary (MEEI), Harvard Medical School, Boston, Massachusetts, USA
| | - Felipe Santos
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary (MEEI), Harvard Medical School, Boston, Massachusetts, USA
| | - Alicia Quesnel
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary (MEEI), Harvard Medical School, Boston, Massachusetts, USA
| | - Michael S Cohen
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary (MEEI), Harvard Medical School, Boston, Massachusetts, USA
| | - Daniel J Lee
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary (MEEI), Harvard Medical School, Boston, Massachusetts, USA
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Kashani RG, Henslee A, Nelson RF, Hansen MR. Robotic assistance during cochlear implantation: the rationale for consistent, controlled speed of electrode array insertion. Front Neurol 2024; 15:1335994. [PMID: 38318440 PMCID: PMC10839068 DOI: 10.3389/fneur.2024.1335994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 01/05/2024] [Indexed: 02/07/2024] Open
Abstract
Cochlear implants (CI) have revolutionized the treatment of patients with severe to profound sensory hearing loss by providing a method of bypassing normal hearing to directly stimulate the auditory nerve. A further advance in the field has been the introduction of "hearing preservation" surgery, whereby the CI electrode array (EA) is carefully inserted to spare damage to the delicate anatomy and function of the cochlea. Preserving residual function of the inner ear allows patients to receive maximal benefit from the CI and to combine CI electric stimulation with acoustic hearing, offering improved postoperative speech, hearing, and quality of life outcomes. However, under the current paradigm of implant surgery, where EAs are inserted by hand, the cochlea cannot be reliably spared from damage. Robotics-assisted EA insertion is an emerging technology that may overcome fundamental human kinetic limitations that prevent consistency in achieving steady and slow EA insertion. This review begins by describing the relationship between EA insertion speed and generation of intracochlear forces and pressures. The various mechanisms by which these intracochlear forces can damage the cochlea and lead to worsened postoperative outcomes are discussed. The constraints of manual insertion technique are compared to robotics-assisted methods, followed by an overview of the current and future state of robotics-assisted EA insertion.
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Affiliation(s)
- Rustin G. Kashani
- Department of Otolaryngology – Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| | | | | | - Marlan R. Hansen
- Department of Otolaryngology – Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
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Khurana L, Harczos T, Moser T, Jablonski L. En route to sound coding strategies for optical cochlear implants. iScience 2023; 26:107725. [PMID: 37720089 PMCID: PMC10502376 DOI: 10.1016/j.isci.2023.107725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023] Open
Abstract
Hearing loss is the most common human sensory deficit. Severe-to-complete sensorineural hearing loss is often treated by electrical cochlear implants (eCIs) bypassing dysfunctional or lost hair cells by direct stimulation of the auditory nerve. The wide current spread from each intracochlear electrode array contact activates large sets of tonotopically organized neurons limiting spectral selectivity of sound coding. Despite many efforts, an increase in the number of independent eCI stimulation channels seems impossible to achieve. Light, which can be better confined in space than electric current may help optical cochlear implants (oCIs) to overcome eCI shortcomings. In this review, we present the current state of the optogenetic sound encoding. We highlight optical sound coding strategy development capitalizing on the optical stimulation that requires fine-grained, fast, and power-efficient real-time sound processing controlling dozens of microscale optical emitters as an emerging research area.
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Affiliation(s)
- Lakshay Khurana
- Institute for Auditory Neuroscience, University Medical Center Göttingen, Göttingen, Germany
- Auditory Neuroscience and Optogenetics Laboratory, German Primate Center, Göttingen, Germany
- Auditory Neuroscience and Synaptic Nanophysiology Group, Max-Planck-Institute for Multidisciplinary Sciences, Göttingen, Germany
- Junior Research Group “Computational Neuroscience and Neuroengineering”, Göttingen, Germany
- The Doctoral Program “Sensory and Motor Neuroscience”, Göttingen Graduate Center for Neurosciences, Biophysics, and Molecular Biosciences (GGNB), Göttingen, Germany
- InnerEarLab, University Medical Center Göttingen, Göttingen, Germany
| | - Tamas Harczos
- Institute for Auditory Neuroscience, University Medical Center Göttingen, Göttingen, Germany
- Auditory Neuroscience and Optogenetics Laboratory, German Primate Center, Göttingen, Germany
| | - Tobias Moser
- Institute for Auditory Neuroscience, University Medical Center Göttingen, Göttingen, Germany
- Auditory Neuroscience and Optogenetics Laboratory, German Primate Center, Göttingen, Germany
- Auditory Neuroscience and Synaptic Nanophysiology Group, Max-Planck-Institute for Multidisciplinary Sciences, Göttingen, Germany
- InnerEarLab, University Medical Center Göttingen, Göttingen, Germany
- Cluster of Excellence “Multiscale Bioimaging: from Molecular Machines to Networks of Excitable Cells” (MBExC), University of Göttingen, Göttingen, Germany
| | - Lukasz Jablonski
- Institute for Auditory Neuroscience, University Medical Center Göttingen, Göttingen, Germany
- Auditory Neuroscience and Optogenetics Laboratory, German Primate Center, Göttingen, Germany
- Junior Research Group “Computational Neuroscience and Neuroengineering”, Göttingen, Germany
- InnerEarLab, University Medical Center Göttingen, Göttingen, Germany
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Geiger L, Zuniga MG, Lenarz T, Majdani O, Rau TS. Drilling accuracy evaluation of a mouldable surgical targeting system for minimally invasive access to anatomic targets in the temporal bone. Eur Arch Otorhinolaryngol 2023; 280:4371-4379. [PMID: 37010602 PMCID: PMC10477231 DOI: 10.1007/s00405-023-07925-x] [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] [Received: 11/18/2022] [Accepted: 03/13/2023] [Indexed: 04/04/2023]
Abstract
PURPOSE Minimally invasive cochlear implant surgery using a micro-stereotactic surgical targeting system with on-site moulding of the template aims for a reliable, less experience-dependent access to the inner ear under maximal reduction of trauma to anatomic structures. We present an accuracy evaluation of our system in ex-vivo testing. METHODS Eleven drilling experiments were performed on four cadaveric temporal bone specimens. The process involved preoperative imaging after affixing the reference frame to the skull, planning of a safe trajectory preserving relevant anatomical structures, customization of the surgical template, execution of the guided drilling and postoperative imaging for determination of the drilling accuracy. Deviation between the drilled and desired trajectories was measured at different depths. RESULTS All drilling experiments were successfully performed. Other than purposely sacrificing the chorda tympani in one experiment, no other relevant anatomy, such as facial nerve, chorda tympani, ossicles or external auditory canal were harmed. Deviation between the desired and achieved path was found to be 0.25 ± 0.16 mm at skulls' surface and 0.51 ± 0.35 mm at the target level. The closest distance of the drilled trajectories' outer circumference to the facial nerve was 0.44 mm. CONCLUSIONS We demonstrated the usability for drilling to the middle ear on human cadaveric specimen in a pre-clinical setting. Accuracy proved to be suitable for many applications such as procedures within the field of image-guided neurosurgery. Promising approaches to reach sufficient submillimetre accuracy for CI surgery have been outlined.
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Affiliation(s)
- Lena Geiger
- Department of Otolaryngology and Cluster of Excellence EXC 2177/1 "Hearing4all", Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - M Geraldine Zuniga
- Department of Otolaryngology and Cluster of Excellence EXC 2177/1 "Hearing4all", Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
- Ear Medical Group, San Antonio, TX, USA
- Tecnologico de Monterrey, Instituto de Otorrinolaringologia, Hospital Zambrano Hellion, TecSalud, San Pedro Garza Garcia, Mexico
| | - Thomas Lenarz
- Department of Otolaryngology and Cluster of Excellence EXC 2177/1 "Hearing4all", Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Omid Majdani
- Department of Otolaryngology and Cluster of Excellence EXC 2177/1 "Hearing4all", Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Thomas S Rau
- Department of Otolaryngology and Cluster of Excellence EXC 2177/1 "Hearing4all", Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
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Robot-Assisted Electrode Insertion in Cochlear Implantation Controlled by Intraoperative Electrocochleography-A Pilot Study. J Clin Med 2022; 11:jcm11237045. [PMID: 36498620 PMCID: PMC9737018 DOI: 10.3390/jcm11237045] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 11/21/2022] [Indexed: 12/03/2022] Open
Abstract
Robotics in otology has been developing in many directions for more than two decades. Current clinical trials focus on more accurate stapes surgery, minimally invasive access to the cochlea and less traumatic insertion of cochlear implant (CI) electrode arrays. In this study we evaluated the use of the RobOtol® (Collin, Bagneux, France) otologic robot to insert CI electrodes into the inner ear with intraoperative ECochG analysis. This prospective, pilot study included two adult patients implanted with Advanced Bionics (Westinghouse PI, CA, USA) cochlear implant, with HiFocus™ Mid-Scala electrode array. The standard surgical approach was used. For both subjects, who had residual hearing in the implanted ear, intraoperative and postoperative ECochG was performed with the AIMTM system. The surgeries were uneventful. A credible ECochG response was obtained after complete electrode insertion in both cases. Preoperative BC thresholds compared to intraoperative estimated ECochG thresholds and 2-day postoperative BC thresholds had similar values at frequencies where all thresholds were measurable. The results of the ECochG performed one month after the surgery showed that in both patients the hearing residues were preserved for the selected frequencies. The RobOtol® surgical robot allows for the correct, safe and gentle insertion of the cochlear implant electrode inside the cochlea. The use of electrocochleography measurements during robotic cochlear implantation offers an additional opportunity to evaluate and modify the electrode array insertion on an ongoing basis, which may contribute to the preservation of residual hearing.
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Khurana L, Keppeler D, Jablonski L, Moser T. Model-based prediction of optogenetic sound encoding in the human cochlea by future optical cochlear implants. Comput Struct Biotechnol J 2022; 20:3621-3629. [PMID: 35860414 PMCID: PMC9283772 DOI: 10.1016/j.csbj.2022.06.061] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 06/28/2022] [Accepted: 06/28/2022] [Indexed: 01/17/2023] Open
Abstract
When hearing fails, electrical cochlear implants (eCIs) partially restore hearing by direct stimulation of spiral ganglion neurons (SGNs). As light can be better confined in space than electrical current, optical CIs (oCIs) provide more spectral information promising a fundamental improvement of hearing restoration by cochlear implants. Here, we turned to computer modelling for predicting the outcome of optogenetic hearing restoration by future oCIs in humans. We combined three-dimensional reconstruction of the human cochlea with ray-tracing simulation of emission from LED or laser-coupled waveguide emitters of the oCI. Irradiance was read out at the somata of SGNs. The irradiance values reached with waveguides were about 14 times higher than with LEDs, at the same radiant flux of the emitter. Moreover, waveguides outperformed LEDs regarding spectral selectivity. oCIs with either emitter type showed greater spectral selectivity when compared to eCI. In addition, modeling the effects of the source-to-SGN distance, orientation of the sources and impact of scar tissue further informs the development of optogenetic hearing restoration.
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Affiliation(s)
- Lakshay Khurana
- Institute for Auditory Neuroscience, University Medical Center Göttingen, Göttingen, Germany
- Auditory Neuroscience and Optogenetics Laboratory, German Primate Center, Göttingen, Germany
- Auditory Neuroscience & Synaptic Nanophysiology Group, Max Planck Institute for Multidisciplinary Sciences, Göttingen, Germany
- Göttingen Graduate Center for Neurosciences, Biophysics, and Molecular Biosciences (GGNB), University of Göttingen, Göttingen, Germany
- InnerEarLab, University Medical Center Göttingen, Göttingen, Germany
| | - Daniel Keppeler
- Institute for Auditory Neuroscience, University Medical Center Göttingen, Göttingen, Germany
- Auditory Neuroscience & Synaptic Nanophysiology Group, Max Planck Institute for Multidisciplinary Sciences, Göttingen, Germany
- InnerEarLab, University Medical Center Göttingen, Göttingen, Germany
| | - Lukasz Jablonski
- Institute for Auditory Neuroscience, University Medical Center Göttingen, Göttingen, Germany
- Auditory Neuroscience and Optogenetics Laboratory, German Primate Center, Göttingen, Germany
- InnerEarLab, University Medical Center Göttingen, Göttingen, Germany
| | - Tobias Moser
- Institute for Auditory Neuroscience, University Medical Center Göttingen, Göttingen, Germany
- Auditory Neuroscience and Optogenetics Laboratory, German Primate Center, Göttingen, Germany
- Auditory Neuroscience & Synaptic Nanophysiology Group, Max Planck Institute for Multidisciplinary Sciences, Göttingen, Germany
- InnerEarLab, University Medical Center Göttingen, Göttingen, Germany
- Cluster of Excellence “Multiscale Bioimaging: from Molecular Machines to Networks of Excitable Cells” (MBExC), University of Göttingen, Göttingen, Germany
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Blebea CM, Ujvary LP, Necula V, Dindelegan MG, Perde-Schrepler M, Stamate MC, Cosgarea M, Maniu AA. Current Concepts and Future Trends in Increasing the Benefits of Cochlear Implantation: A Narrative Review. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:747. [PMID: 35744010 PMCID: PMC9229893 DOI: 10.3390/medicina58060747] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 05/25/2022] [Accepted: 05/29/2022] [Indexed: 01/29/2023]
Abstract
Hearing loss is the most common neurosensory disorder, and with the constant increase in etiological factors, combined with early detection protocols, numbers will continue to rise. Cochlear implantation has become the gold standard for patients with severe hearing loss, and interest has shifted from implantation principles to the preservation of residual hearing following the procedure itself. As the audiological criteria for cochlear implant eligibility have expanded to include patients with good residual hearing, more attention is focused on complementary development of otoprotective agents, electrode design, and surgical approaches. The focus of this review is current aspects of preserving residual hearing through a summary of recent trends regarding surgical and pharmacological fundamentals. Subsequently, the assessment of new pharmacological options, novel bioactive molecules (neurotrophins, growth factors, etc.), nanoparticles, stem cells, and gene therapy are discussed.
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Affiliation(s)
- Cristina Maria Blebea
- Department of Otorhinolaryngology, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400347 Cluj Napoca, Romania; (C.M.B.); (V.N.); (M.G.D.); (M.C.S.); (M.C.); (A.A.M.)
| | - Laszlo Peter Ujvary
- Department of Otorhinolaryngology, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400347 Cluj Napoca, Romania; (C.M.B.); (V.N.); (M.G.D.); (M.C.S.); (M.C.); (A.A.M.)
| | - Violeta Necula
- Department of Otorhinolaryngology, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400347 Cluj Napoca, Romania; (C.M.B.); (V.N.); (M.G.D.); (M.C.S.); (M.C.); (A.A.M.)
- County Clinical Emergency Hospital Cluj, 400347 Cluj Napoca, Romania
| | - Maximilian George Dindelegan
- Department of Otorhinolaryngology, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400347 Cluj Napoca, Romania; (C.M.B.); (V.N.); (M.G.D.); (M.C.S.); (M.C.); (A.A.M.)
| | | | - Mirela Cristina Stamate
- Department of Otorhinolaryngology, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400347 Cluj Napoca, Romania; (C.M.B.); (V.N.); (M.G.D.); (M.C.S.); (M.C.); (A.A.M.)
| | - Marcel Cosgarea
- Department of Otorhinolaryngology, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400347 Cluj Napoca, Romania; (C.M.B.); (V.N.); (M.G.D.); (M.C.S.); (M.C.); (A.A.M.)
| | - Alma Aurelia Maniu
- Department of Otorhinolaryngology, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400347 Cluj Napoca, Romania; (C.M.B.); (V.N.); (M.G.D.); (M.C.S.); (M.C.); (A.A.M.)
- County Clinical Emergency Hospital Cluj, 400347 Cluj Napoca, Romania
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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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