Implementation of Robot-Assisted Minimally Invasive Cochlear Implantation: A Feasibility Study.

Objective: This study aimed to investigate if robot-assisted image-guided cochlear implant surgery can be used efficiently and safely in our center.

Study design: Clinical prospective interventional monocentric study.

Setting: The study was conducted in subjects over the age of 18 years who underwent unilateral cochlear implantation using a robotic system between September 2021 and December 2022.

Patients: Subjects were included if the anatomy allowed for a safe trajectory for direct cochlear access to be planned.

Intervention: Subjects underwent surgery using the robotic procedure.

Main outcome measures: The ratio of successful electrode array insertions through the robotically drilled tunnel.

Results: Ten subjects were included. The robot-assisted procedure was successful in nine cases (one bur failure). No case of facial palsy was observed. The mean drilling accuracy was 0.13 ± 0.08 mm (range, 0.03-0.26 mm) at the facial nerve, 0.14 ± 0.09 mm (range, 0.07-0.38 mm) at the chorda tympani, and 0.2 ± 0.12 mm (range, 0.03-0.26 mm) at the round window. In all robotically drilled cases, it was possible to insert the electrode array through the tunnel. One case required a second-turn cochleostomy due to an unexpected fibrosis of the basal turn. One case of partial electrode array insertion required conversion to standard procedure, which showed no improvement. For the remaining seven cases, the mean insertion depth was 520 ± 104 degrees (range, 378-712 degrees). The surgical time was 247 ± 37 minutes (range, 177-299 minutes).

Conclusion: This study demonstrated the safety and efficiency of the direct tunnel approach.