title: A smart micro-drill for cochleostomy formation: a comparison of cochlear disturbances with manual drilling and a human trial.
abstract: BACKGROUND
  Cochleostomy formation is a key stage of the cochlear implantation procedure. Minimizing the trauma sustained by the cochlea during this step is thought to be a critical feature in hearing preservation cochlear implantation. The aim of this paper is firstly, to assess the cochlea disturbances during manual and robotic cochleostomy formation. Secondly, to determine whether the use of a smart micro-drill is feasible during human cochlear implantation.
  
  
  METHODS
  The disturbances within the cochlea during cochleostomy formation were analysed in a porcine specimen by creating a third window cochleostomy, preserving the underlying endosteal membrane, on the anterior aspect of the basal turn of the cochlea. A laser vibrometer was aimed at this third window, to assess its movement while a traditional cochleostomy was performed. Six cochleostomies were performed in total, three manually and three with a smart micro-drill. The mean and peak membrane movement was calculated for both manual and smart micro-drill arms, to represent the disturbances sustained within cochlea during cochleostomy formation. The smart micro-drill was further used to perform live human robotic cochleostomies on three adult patients who met the National Institute of Health and Clinical Excellence criteria for undergoing cochlear implantation.
  
  
  RESULTS
  In the porcine trial, the smart micro-drill preserved the endosteal membrane in all three cases. The velocity of movement of the endosteal membrane during manual cochleostomy is approximately 20 times higher on average and 100 times greater in peak velocity, than for robotic cochleostomy. The robot was safely utilized in theatre in all three cases and successfully created a bony cochleostomy while preserving the underlying endosteal membrane.
  
  
  CONCLUSIONS
  Our experiments have revealed that controlling the force of drilling during cochleostomy formation and opening the endosteal membrane with a pick will minimize the trauma sustained by the cochlea by a factor of 20. Additionally, the smart micro-drill can safely perform a bony cochleostomy in humans under operative conditions and preserve the integrity of the underlying endosteal membrane.
authors.affiliation: ENT Department, Queen Elizabeth Hospital, Edgbaston, Birmingham B15 2TH, UK. christopher.coulson@uhb.nhs.uk
authors.forename: C J
authors.initials: CJ
authors.lastname: Coulson
authors.forename: M Zoka
authors.initials: MZ
authors.lastname: Assadi
authors.forename: R P
authors.initials: RP
authors.lastname: Taylor
authors.forename: X
authors.initials: X
authors.lastname: Du
authors.forename: P N
authors.initials: PN
authors.lastname: Brett
authors.forename: A P
authors.initials: AP
authors.lastname: Reid
authors.forename: D W
authors.initials: DW
authors.lastname: Proops
mesh_terms: D000818:Animals; D003051:Cochlea / Q000601:surgery*; D019929:Cochlear Implantation / Q000295:instrumentation*; D004867:Equipment Design; D006801:Humans; D008866:Microsurgery / Q000295:instrumentation*; D012371:Robotics; D025321:Surgery, Computer-Assisted / Q000295:instrumentation*; D013525:Surgical Instruments; D013552:Swine