title: Atraumatic surgical approach to the cochlea with a micromanipulator.
abstract: CONCLUSIONS
  Our design and preliminary results show that the the micromanipulator could be a great help to the surgeon in the atraumatic surgical approach to the lateral wall of the cochlea at the promontory.
  
  
  OBJECTIVE
  Hearing preservation in cochlear implant opens new frontiers in the treatment of sensorineural hearing loss. To preserve the membranous labyrinth intact, new surgical tools are needed, either for cochlear implantation or for other applications. The objectives of this study were to design and test a micromanipulator coupled to a drilling tool for the atraumatic exposure of the spiral ligament. The micromanipulator is designed to increase precision when drilling the otic capsule bone.
  
  
  METHODS
  A group from the University of Navarra worked on the device design -- based on a compliant mechanism -- and in vitro test. The components and functioning of the micromanipulator are described. It was tested in 10 formalinized temporal bones after a mastoidectomy, a posterior tympanotomy, and a transcanal tympanotomy were performed. The micromanipulator was placed over the cranial surface, and used to expose the endostium, anteriorly to the round window niche.
  
  
  RESULTS
  A combined approach through the external auditory canal was feasible, together with a posterior tympanotomy to visually control the work and make complementary manoeuvres. Drilling was easy, and visual control through the posterior tympanotomy was excellent. A high degree of drilling precision was achieved. A little disruption of the membranous labyrinth was found only in the first bone of the series.
authors.affiliation: Department of Otorhinolaryngology, Head & Neck Surgery, Clinica Universitaria, University of Navarra, Pamplona, Spain.
authors.forename: Manuel J
authors.initials: MJ
authors.lastname: Manrique
authors.forename: Joan
authors.initials: J
authors.lastname: Savall
authors.forename: Francisco Javier
authors.initials: FJ
authors.lastname: Cervera-Paz
authors.forename: Jorge
authors.initials: J
authors.lastname: Rey
authors.forename: Carolina
authors.initials: C
authors.lastname: Der
authors.forename: Mikel
authors.initials: M
authors.lastname: Echeverria
authors.forename: Mikel
authors.initials: M
authors.lastname: Ares
mesh_terms: D003051:Cochlea / Q000601:surgery*; D004867:Equipment Design; D006801:Humans; D010036:Otolaryngology / Q000295:instrumentation*; D013525:Surgical Instruments; D013701:Temporal Bone / Q000601:surgery