title: Improvement of the insertion axis for cochlear implantation with a robot-based system.
abstract: It has previously reported that alignment of the insertion axis along the basal turn of the cochlea was depending on surgeon' experience. In this experimental study, we assessed technological assistances, such as navigation or a robot-based system, to improve the insertion axis during cochlear implantation. A preoperative cone beam CT and a mastoidectomy with a posterior tympanotomy were performed on four temporal bones. The optimal insertion axis was defined as the closest axis to the scala tympani centerline avoiding the facial nerve. A neuronavigation system, a robot assistance prototype, and software allowing a semi-automated alignment of the robot were used to align an insertion tool with an optimal insertion axis. Four procedures were performed and repeated three times in each temporal bone: manual, manual navigation-assisted, robot-based navigation-assisted, and robot-based semi-automated. The angle between the optimal and the insertion tool axis was measured in the four procedures. The error was 8.3° ± 2.82° for the manual procedure (n = 24), 8.6° ± 2.83° for the manual navigation-assisted procedure (n = 24), 5.4° ± 3.91° for the robot-based navigation-assisted procedure (n = 24), and 3.4° ± 1.56° for the robot-based semi-automated procedure (n = 12). A higher accuracy was observed with the semi-automated robot-based technique than manual and manual navigation-assisted (p < 0.01). Combination of a navigation system and a manual insertion does not improve the alignment accuracy due to the lack of friendly user interface. On the contrary, a semi-automated robot-based system reduces both the error and the variability of the alignment with a defined optimal axis.
authors.affiliation: Sorbonne Universités, Université Pierre et Marie Curie Paris 6 (UPMC Paris 6), Inserm, UMR-S 1159 Réhabilitation chirurgicale mini-invasive et robotisée de l'audition, 16, rue Henri Huchard, 75018, Paris, France.|AP-HP, GHU Pitié-Salpêtrière, Service ORL, Otologie, implants auditifs et chirurgie de la base du crâne, Paris, France.
authors.forename: Renato
authors.identifier: http://orcid.org/0000-0001-6701-6793
authors.initials: R
authors.lastname: Torres
authors.affiliation: Sorbonne Universités, Université Pierre et Marie Curie Paris 6 (UPMC Paris 6), Inserm, UMR-S 1159 Réhabilitation chirurgicale mini-invasive et robotisée de l'audition, 16, rue Henri Huchard, 75018, Paris, France.|Université Lille-1, Lille Nord-Europe, Team Defrost Inria, Lille, France.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Kazmitcheff
authors.affiliation: Sorbonne Universités, Université Pierre et Marie Curie Paris 6 (UPMC Paris 6), Inserm, UMR-S 1159 Réhabilitation chirurgicale mini-invasive et robotisée de l'audition, 16, rue Henri Huchard, 75018, Paris, France.|AP-HP, GHU Pitié-Salpêtrière, Service ORL, Otologie, implants auditifs et chirurgie de la base du crâne, Paris, France.
authors.forename: Daniele
authors.initials: D
authors.lastname: De Seta
authors.affiliation: Sorbonne Universités, Université Pierre et Marie Curie Paris 6 (UPMC Paris 6), Inserm, UMR-S 1159 Réhabilitation chirurgicale mini-invasive et robotisée de l'audition, 16, rue Henri Huchard, 75018, Paris, France.|AP-HP, GHU Pitié-Salpêtrière, Service ORL, Otologie, implants auditifs et chirurgie de la base du crâne, Paris, France.
authors.forename: Evelyne
authors.initials: E
authors.lastname: Ferrary
authors.affiliation: Sorbonne Universités, Université Pierre et Marie Curie Paris 6 (UPMC Paris 6), Inserm, UMR-S 1159 Réhabilitation chirurgicale mini-invasive et robotisée de l'audition, 16, rue Henri Huchard, 75018, Paris, France.|AP-HP, GHU Pitié-Salpêtrière, Service ORL, Otologie, implants auditifs et chirurgie de la base du crâne, Paris, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Sterkers
authors.affiliation: Sorbonne Universités, Université Pierre et Marie Curie Paris 6 (UPMC Paris 6), Inserm, UMR-S 1159 Réhabilitation chirurgicale mini-invasive et robotisée de l'audition, 16, rue Henri Huchard, 75018, Paris, France. yann.nguyen@inserm.fr.|AP-HP, GHU Pitié-Salpêtrière, Service ORL, Otologie, implants auditifs et chirurgie de la base du crâne, Paris, France. yann.nguyen@inserm.fr.
authors.forename: Yann
authors.initials: Y
authors.lastname: Nguyen
mesh_terms: D002102:Cadaver; D019929:Cochlear Implantation / Q000379:methods*; D054893:Cone-Beam Computed Tomography; D006801:Humans; D065287:Robotic Surgical Procedures; D013701:Temporal Bone / Q000000981:diagnostic imaging / Q000601:surgery
keywords: Axis improvement; Computer-assisted surgery; Navigation; Robot-based insertion