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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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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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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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Du X, Brett PN, Zhang Y, Begg P, Mitchell-Innes A, Coulson C, Irving R. A hand-guided robotic drill for cochleostomy on human cadavers. ROBOTIC SURGERY : RESEARCH AND REVIEWS 2019; 5:13-18. [PMID: 30697569 PMCID: PMC6193445 DOI: 10.2147/rsrr.s142562] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background An arm supported robotic drill has been recently demonstrated for preparing cochleostomies in a pilot research clinical trial. In this paper, a hand-guided robotic drill is presented and tested on human cadaver trials. Methods The innovative smart tactile approach can automatically detect drilling mediums and decided when to stop drilling to prevent penetrating the endosteum. The smart sensing scheme has been implemented in a concept of a hand guided robotic drill. Results Experiments were carried out on two adult cadaveric human bodies for verifying the drilling process and successfully finished cochleostomy on three cochlea. The advantage over a system supported by a mechanical arm includes the flexibility in adjusting the trajectory to initiate cutting without slipping. Using the same concept as a conventional drilling device, the user will also be benefit from the lower setup time and cost, and lower training overhead. Conclusion The hand-guided robotic drill was recently developed for testing on human cadavers. The robotic drill successfully prepared cochleostomies in all three cases.
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Affiliation(s)
- Xinli Du
- Brunel Institute for Bioengineering, Brunel University London, Uxbridge, UK,
| | - Peter N Brett
- University of Southern Queensland, Toowoomba, QLD, Australia
| | - Yu Zhang
- Brunel Institute for Bioengineering, Brunel University London, Uxbridge, UK,
| | - Philip Begg
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Chris Coulson
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Richard Irving
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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Fan X, Xia M, Wang Z, Zhang H, Liu C, Wang N, Hou L, Li C, Xu A. Comparison of electrode position between round window and cochleostomy inserting approaches among young children: a cone-beam computed tomography study. Acta Otolaryngol 2018; 138:815-821. [PMID: 29936898 DOI: 10.1080/00016489.2018.1478127] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND As the two most commonly used approaches for cochlear implants (CIs), the round-window insertion (RWI) and cochleostomy are still controversial about which approach is optimal. The lack of visual observation methods makes it difficult to compare the electrode position between them. OBJECTIVES To evaluate and compare the electrode position between RWI and cochleostomy approaches for CI among young children. MATERIALS AND METHODS Twenty-four patients (16 male, 8 female) accepting CI and temporal cone-beam computed tomography (CBCT) scan post-operation in our hospital from January 2016 to July 2017 were analyzed retrospectively. Operative notes and images were used to identify the surgical technique. Mainly depending on the round-window exposure, 15 cochleae were performed with RWI and 11 performed with cochleostomy. RESULTS Mean age, 2.4 (range 0.8-7) years. The CBCT images showed that all the electrode arrays were located in scala tympani. There were no significantly statistical differences in the distance between electrode contacts and modiolus (EMI), intracochlear insertion length and the angle of electrode arrays at the insertion site of the cochlea. CONCLUSIONS AND SIGNIFICANCE Both approaches could insert electrodes into scala tympani satisfactorily. As electrodes and cochlear structures could be clearly visualized, CBCT can be applied to assess the electrode position reliably.
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Affiliation(s)
- Xintai Fan
- Department of Otorhinolaryngology & Head and Neck Surgery, The Second Hospital of Shandong University, Jinan, China
| | - Ming Xia
- Department of Otorhinolaryngology & Head and Neck Surgery, The Second Hospital of Shandong University, Jinan, China
| | - Zhe Wang
- Department of Otorhinolaryngology & Head and Neck Surgery, The Second Hospital of Shandong University, Jinan, China
| | - Hui Zhang
- Department of Otorhinolaryngology & Head and Neck Surgery, The Second Hospital of Shandong University, Jinan, China
| | - Chengcheng Liu
- Department of Otorhinolaryngology & Head and Neck Surgery, The Second Hospital of Shandong University, Jinan, China
| | - Na Wang
- Department of Otorhinolaryngology & Head and Neck Surgery, The Second Hospital of Shandong University, Jinan, China
| | - Lingxiao Hou
- Department of Otorhinolaryngology & Head and Neck Surgery, The Second Hospital of Shandong University, Jinan, China
| | - Chen Li
- Department of Otorhinolaryngology & Head and Neck Surgery, The Second Hospital of Shandong University, Jinan, China
| | - Anting Xu
- Department of Otorhinolaryngology & Head and Neck Surgery, The Second Hospital of Shandong University, Jinan, China
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Weber S, Gavaghan K, Wimmer W, Williamson T, Gerber N, Anso J, Bell B, Feldmann A, Rathgeb C, Matulic M, Stebinger M, Schneider D, Mantokoudis G, Scheidegger O, Wagner F, Kompis M, Caversaccio M. Instrument flight to the inner ear. Sci Robot 2017; 2:eaal4916. [PMID: 30246168 PMCID: PMC6150423 DOI: 10.1126/scirobotics.aal4916] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Surgical robot systems can work beyond the limits of human perception, dexterity and scale making them inherently suitable for use in microsurgical procedures. However, despite extensive research, image-guided robotics applications for microsurgery have seen limited introduction into clinical care to date. Among others, challenges are geometric scale and haptic resolution at which the surgeon cannot sufficiently control a device outside the range of human faculties. Mechanisms are required to ascertain redundant control on process variables that ensure safety of the device, much like instrument-flight in avionics. Cochlear implantation surgery is a microsurgical procedure, in which specific tasks are at sub-millimetric scale and exceed reliable visuo-tactile feedback. Cochlear implantation is subject to intra- and inter-operative variations, leading to potentially inconsistent clinical and audiological outcomes for patients. The concept of robotic cochlear implantation aims to increase consistency of surgical outcomes such as preservation of residual hearing and reduce invasiveness of the procedure. We report successful image-guided, robotic CI in human. The robotic treatment model encompasses: computer-assisted surgery planning, precision stereotactic image-guidance, in-situ assessment of tissue properties and multipolar neuromonitoring (NM), all based on in vitro, in vivo and pilot data. The model is expandable to integrate additional robotic functionalities such as cochlear access and electrode insertion. Our results demonstrate the feasibility and possibilities of using robotic technology for microsurgery on the lateral skull base. It has the potential for benefit in other microsurgical domains for which there is no task-oriented, robotic technology available at present.
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Affiliation(s)
- Stefan Weber
- ARTORG Center for Biomedical Engineering Research, University of Bern
| | - Kate Gavaghan
- ARTORG Center for Biomedical Engineering Research, University of Bern
| | - Wilhelm Wimmer
- ARTORG Center for Biomedical Engineering Research, University of Bern
- Department of Otorhinolaryngology, Head and Neck Surgery, lnselspital, Bern University Hospital
| | - Tom Williamson
- ARTORG Center for Biomedical Engineering Research, University of Bern
| | - Nicolas Gerber
- ARTORG Center for Biomedical Engineering Research, University of Bern
| | - Juan Anso
- ARTORG Center for Biomedical Engineering Research, University of Bern
| | - Brett Bell
- ARTORG Center for Biomedical Engineering Research, University of Bern
| | - Arne Feldmann
- Institute for Surgical Technologies and Biomechanics, University of Bern
| | - Christoph Rathgeb
- ARTORG Center for Biomedical Engineering Research, University of Bern
| | - Marco Matulic
- ARTORG Center for Biomedical Engineering Research, University of Bern
| | - Manuel Stebinger
- ARTORG Center for Biomedical Engineering Research, University of Bern
| | - Daniel Schneider
- ARTORG Center for Biomedical Engineering Research, University of Bern
| | - Georgios Mantokoudis
- Department of Otorhinolaryngology, Head and Neck Surgery, lnselspital, Bern University Hospital
| | | | - Franca Wagner
- Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital
| | - Martin Kompis
- Department of Otorhinolaryngology, Head and Neck Surgery, lnselspital, Bern University Hospital
| | - Marco Caversaccio
- ARTORG Center for Biomedical Engineering Research, University of Bern
- Department of Otorhinolaryngology, Head and Neck Surgery, lnselspital, Bern University Hospital
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