title: Friction force measurement during cochlear implant insertion:  application to a force-controlled insertion tool design.
abstract: OBJECTIVE
  The aim of the study was to evaluate force profiles during array insertion in human cochlea specimens and to evaluate a mechatronic inserter using a 1-axis force sensor.
  
  
  BACKGROUND
  Today, the surgical challenge in cochlear implantation is the preservation of the anatomic structures and the residual hearing. In routine practice, the electrode array is inserted manually with a limited sensitive feedback.
  
  
  METHODS
  Hifocus 1J electrode arrays were studied. The bench test comprised a mechatronic inserter combined to a 1-axis force sensor between the inserter and the base of the array and a 6-axis force sensor beneath the cochlea model. Influence of insertion tube material, speed (0.15, 0.5, and 1.5 mm/s) and lubricant on frictions forces were studied (no-load). Different models were subsequently evaluated: epoxy scala tympani model and temporal bones.
  
  
  RESULTS
  Frictions forces were lower in the plastic tube compared with those in the metal tube (0.09 ± 0.028 versus 0.14 ± 0.034 at 0.5 mm/s, p < 0.001) and with the use of hyaluronic acid gel. Speed did not influence frictions forces in our study. Insertion force profiles provided by the 1- and 6-axis force sensors were similar when friction forces inside the insertion tool (no-load measurements) were subtracted from the 1-axis sensor data in the epoxy and temporal bone models (mean error, 0.01 ± 0.001 N).
  
  
  CONCLUSIONS
  Using a sensor included in the inserter, we were able to measure array insertion forces. This tool can be potentially used to provide real-time information to the surgeon during the procedure.
authors: Paris Diderot Univ, Sorbonne Paris Cité, Laboratoire, Paris, France.
authors: Mathieu
authors: M
authors: Miroir
authors: Yann
authors: Y
authors: Nguyen
authors: Guillaume
authors: G
authors: Kazmitcheff
authors: Evelyne
authors: E
authors: Ferrary
authors: Olivier
authors: O
authors: Sterkers
authors: Alexis Bozorg
authors: AB
authors: Grayeli
mesh_terms: D003051:Cochlea / Q000502:physiology; D019929:Cochlear Implantation / Q000295:instrumentation* / Q000379:methods; D003054:Cochlear Implants; D004566:Electrodes; D017276:Friction; D006801:Humans; D066298:In Vitro Techniques; D008953:Models, Anatomic; D012533:Scala Tympani / Q000502:physiology; D013701:Temporal Bone / Q000033:anatomy & histology