Caversaccio M1,2, Williamson T3, Gavaghan K2, Gerber N2, Wimmer W1,2, Anso J3, Rathgeb C2 , Wagner F, Weber S 2
1 Department of ENT, Head and Neck Surgery, University Hospital, Bern, Switzerland 2 ARTORG Center, Bern, Switzerland
Learning Objectives:
Objectives: Over the last decade significant research efforts have been invested towards the application of surgical robotics for cochlear implant surgery. To this end, a high accuracy image guided robotic manipulator was developed at the University of Bern, allowing minimally invasive access to the cochlea. This work aims to evaluate the accuracy and usability of the developed system in a study on human temporal specimens.
Methods: A complete surgical workflow for robotic assisted minimally invasive cochlear implantation, including fiducial screw insertion, pre-operative imaging, semi-automatic trajectory planning, patient-to-image registration, tunnel drilling, and electrode array insertion was developed. The proposed workflow, the accuracy of the robotic system, and the effectiveness of the integrated safety features were evaluated in a total of 22 human temporal bone specimens.
Results: In all cases, access to the cochlea was successfully obtained. A drilling accuracy of 0.15 ± 0.07 mm was observed at the round window of cochlea as determined from post-operative image data. The additional mechanisms provide a means to monitor the safety of the approach during the surgery. The system is approved by the Swissmedic regulatory and the Swiss Ethical Committee has given permission for a first in man clinical trial.
Conclusions: The robotic system allows the accurate and safe drilling of a minimally invasive tunnel to the inner ear for cochlear implantation procedures. The evaluation of the system in a first in man clinical trial will take place in the near future.
Acknowledgments: Artorgcenter (Prof. S. Weber and coworkers), Medel-company, Nano-Tera, CTI, Hear-EU.
