Learning Objectives: Cochlear implantation leads to cochlear trauma, reducing this may help optimize implantation performance. An autonomous cochlea drilling robot may be one of the components in reducing this trauma.

Introduction: To detail the intra cochlear trauma caused during cochlear implantation and its effect on CI performance. To demonstrate a human trial of an autonomous robot capable of performing a bony cochleostomy whilst preserving the underlying endosteal membrane.

Methods: A review of the implantation literature assessing cochlear trauma and its impact on implant performance. An autonomous cochleostomy robot was used to create a cochleostomy in 3 live patients during a cochlear implantation procedure.

Results: Twenty one papers were identified which were relevant to our search. In total, 686 implants were inserted and 121 (17.6%) showed evidence of trauma.

The robotic cochleostomy drilling robot was able to perform a complete cochleostomy whilst preserving the underlying endosteal membrane.

Conclusions: Cochlea trauma is a common result of cochlear implantation. An autonomous robotic drill can perform a cochleostomy whilst preserving the underlying endosteal membrane. This is one of the necessary steps in being able to perform a completely robotic cochlear implantation - with an intention to reduce the typical cochlear trauma.