title: Manual Electrode Array Insertion Through a Robot-Assisted Minimal Invasive Cochleostomy: Feasibility and Comparison of Two Different Electrode Array Subtypes.
abstract: OBJECTIVE
  To evaluate the feasibility and the results of insertion of two types of electrode arrays in a robotically assisted surgical approach.
  
  
  BACKGROUND
  Recent publications demonstrated that robot-assisted surgery allows the implantation of free-fitting electrode arrays through a cochleostomy drilled via a narrow bony tunnel (DCA). We investigated if electrode arrays from different manufacturers could be used with this approach.
  
  
  METHODS
  Cone-beam CT imaging was performed on five-cadaveric heads after placement of fiducial screws. Relevant anatomical structures were segmented and the DCA trajectory, including the position of the cochleostomy, was defined to target the center of the scala tympani while reducing the risk of lesions to the facial nerve. Med-El Flex 28 and Cochlear CI422 electrodes were implanted on both sides, and their position was verified by cone-beam CT. Finally, temporal bones were dissected to assess the occurrence of damage to anatomical structures during DCA drilling.
  
  
  RESULTS
  The cochleostomy site was directed in the scala tympani in 9 of 10 cases. The insertion of electrode arrays was successful in 19 of 20 attempts. No facial nerve damage was observed. The average difference between the planned and the postoperative trajectory was 0.17 ± 0.19 mm at the level of the facial nerve. The average depth of insertion was 305.5 ± 55.2 and 243 ± 32.1 degrees with Med-El and Cochlear arrays, respectively.
  
  
  CONCLUSIONS
  Robot-assisted surgery is a reliable tool to allow cochlear implantation through a cochleostomy. Technical solutions must be developed to improve the electrode array insertion using this approach.
authors: *Otology and Neurotology Department, University Hospital of Montpellier, Montpellier, France; †Institute for Neurosciences of Montpellier, INSERM U1051, Montpellier, France; ‡ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland; §Department of ENT, Head and Neck Surgery, Inselspital, University of Bern, Bern, Switzerland; and ∥Anatomy Laboratory, Faculty of Medicine, University Hospital of Montpellier, Montpellier, France.
authors: Frederic
authors: F
authors: Venail
authors: Brett
authors: B
authors: Bell
authors: Mohamed
authors: M
authors: Akkari
authors: Wilhelm
authors: W
authors: Wimmer
authors: Tom
authors: T
authors: Williamson
authors: Nicolas
authors: N
authors: Gerber
authors: Kate
authors: K
authors: Gavaghan
authors: Francois
authors: F
authors: Canovas
authors: Stefan
authors: S
authors: Weber
authors: Marco
authors: M
authors: Caversaccio
authors: Alain
authors: A
authors: Uziel
mesh_terms: D001863:Bone Screws; D002102:Cadaver; D019929:Cochlear Implantation / Q000379:methods*; D003054:Cochlear Implants; D054893:Cone-Beam Computed Tomography; D004567:Electrodes, Implanted; D005240:Feasibility Studies; D006801:Humans; D013506:Otologic Surgical Procedures / Q000379:methods*; D012371:Robotics; D012533:Scala Tympani / Q000000981:diagnostic imaging / Q000601:surgery; D013525:Surgical Instruments; D016896:Treatment Outcome