Neurotology Fellow UC San Diego San Diego, California
Hypothesis: Robotics-assisted cochlear implant (CI) electrode array insertions will result in improved trauma scoring when compared to manual.
Background: Although techniques to reduce intracochlear trauma and translocations are well established, significant variability in CI outcomes remains. To address this issue, we have developed a robotics-assisted insertion system designed to aid the surgeon in inserting electrode arrays with consistent speeds and reduced variability. This study evaluated the effect of robotics-assisted insertions on the intracochlear trauma as compared to manual insertions in cadaveric cochleae in a simulated operative environment.
Methods: Using a round window approach, 12 neurotologists performed bilateral electrode insertions into cochlea of full cadaveric heads using both the robotics-assisted system and manual insertion by hand. Lateral wall electrodes from 3 different manufacturers (n=24) were utilized and randomized between surgeons. Insertion angle of the electrode and trauma scoring were evaluated using high resolution 3D X-ray microscopy and compared between robotics-assisted and manual insertions.
Results: 3D X-ray microscopy provided sufficient resolution to characterize the in situ trauma and insertion angle. Roboticsassisted insertions significantly decreased the trauma score compared to manual insertions (average 1.3 vs 2.2, device vs manual respectively, p<0.05 Wilcoxon signed-rank test). There was no significant difference between insertion angles observed for both manual and robotics-assisted techniques (328±87° vs 335±109°, device vs manual respectively).
Conclusions: Robotics-assisted insertion systems provide a means to standardize electrode insertions across individual surgeons and experience levels. Insertion techniques which reduce insertional variability and the likelihood of intracochlear trauma have the potential to improve CI outcomes.
*Professional Practice Gap & Educational Need: The need for atraumatic techniques during CI electrode insertion is well established, but the effects of insertion speed and variability on intracochlear trauma-related events are not well defined or characterized.
*Learning Objective: To evaluate the difference in electrode translocation incidence during robotics-assisted CI electrode insertions vs. manual (by-hand) insertions in cadaveric cochleae.
*Desired Result: Understand quantified difference in intracochlear trauma score of electrodes inserted with roboticsassisted device vs. manual insertions; and be aware of human related limitations of manual electrode insertions.