title: A robot-guided minimally invasive approach for cochlear implant surgery: preliminary results of a temporal bone study.
abstract: OBJECTIVE
  The aim of this study was to create an access canal to the inner ear, by drilling, and perform the cochleostomy for cochlear implant surgery using robot guidance.
  
  
  METHODS
  A robot, a surgical drill and an Image-Guided Surgery (IGS) system were combined in a closed-loop setup. Ten temporal bones were scanned at the planning stages of the procedure. The robot guided the drill along the preplanned trajectory and created the approach. Postoperative scans were obtained.
  
  
  RESULTS
  The cochleostomy was performed completely in nine out of ten cases. This did not prove possible for one of the specimens, the target site selected being in too superficial a location in relation to the round window. No violation of the facial nerve took place, although the chorda tympani nerve was violated in one case and the stapes in two. It was obvious during preoperative planning that these structures would be violated, but this was accepted in order to maintain a safety margin from the facial nerve. No other unforeseen damage occurred.
  
  
  CONCLUSIONS
  This preliminary study suggests that robot-guided drilling of a minimally invasive approach to the cochlea might be feasible, but further improvements are necessary before any clinical application becomes possible. Where the width of the facial recess is less than 2.5 mm, the chorda tympani nerve and the ossicles are at risk.
authors.affiliation: Department of Otolaryngology Head and Neck Surgery, Clinic for Otolaryngology, Hannover Medical School, Carl-Neuberg-Str. 1, OE 6500, 30625, Hannover, Germany. Majdani.Omid@MH-Hannover.de
authors.forename: Omid
authors.initials: O
authors.lastname: Majdani
authors.forename: Thomas S
authors.initials: TS
authors.lastname: Rau
authors.forename: Stephan
authors.initials: S
authors.lastname: Baron
authors.forename: Hubertus
authors.initials: H
authors.lastname: Eilers
authors.forename: Claas
authors.initials: C
authors.lastname: Baier
authors.forename: Bodo
authors.initials: B
authors.lastname: Heimann
authors.forename: Tobias
authors.initials: T
authors.lastname: Ortmaier
authors.forename: Sönke
authors.initials: S
authors.lastname: Bartling
authors.forename: Thomas
authors.initials: T
authors.lastname: Lenarz
authors.forename: Martin
authors.initials: M
authors.lastname: Leinung
mesh_terms: D002102:Cadaver; D003051:Cochlea / Q000601:surgery*; D019929:Cochlear Implantation / Q000379:methods*; D006801:Humans; D010030:Ostomy / Q000379:methods*; D015203:Reproducibility of Results; D012371:Robotics; D025321:Surgery, Computer-Assisted; D013701:Temporal Bone / Q000601:surgery*; D014057:Tomography, X-Ray Computed