title: Robotic cochlear implantation: surgical procedure and first clinical experience.
abstract: CONCLUSIONS
  A system for robotic cochlear implantation (rCI) has been developed and a corresponding surgical workflow has been described. The clinical feasibility was demonstrated through the conduction of a safe and effective rCI procedure.
  
  
  OBJECTIVE
  To define a clinical workflow for rCI and demonstrate its feasibility, safety, and effectiveness within a clinical setting.
  
  
  METHODS
  A clinical workflow for use of a previously described image guided surgical robot system for rCI was developed. Based on pre-operative images, a safe drilling tunnel targeting the round window was planned and drilled by the robotic system. Intra-operatively the drill path was assessed using imaging and sensor-based data to confirm the proximity of the facial nerve. Electrode array insertion was manually achieved under microscope visualization. Electrode array placement, structure preservation, and the accuracy of the drilling and of the safety mechanisms were assessed on post-operative CT images.
  
  
  RESULTS
  Robotic drilling was conducted with an accuracy of 0.2 mm and safety mechanisms predicted proximity of the nerves to within 0.1 mm. The approach resulted in a minimal mastoidectomy and minimal incisions. Manual electrode array insertion was successfully performed through the robotically drilled tunnel. The procedure was performed without complications, and all surrounding structures were preserved.
authors.affiliation: a Department of ENT, Head and Neck Surgery , Inselspital, Bern University Hospital, University of Bern , Bern , Switzerland.|b Image-Guided Therapy and Artificial Hearing Research, ARTORG Center for Biomedical Engineering Research , University of Bern , Bern , Switzerland.
authors.forename: Marco
authors.initials: M
authors.lastname: Caversaccio
authors.affiliation: b Image-Guided Therapy and Artificial Hearing Research, ARTORG Center for Biomedical Engineering Research , University of Bern , Bern , Switzerland.
authors.forename: Kate
authors.initials: K
authors.lastname: Gavaghan
authors.affiliation: a Department of ENT, Head and Neck Surgery , Inselspital, Bern University Hospital, University of Bern , Bern , Switzerland.|b Image-Guided Therapy and Artificial Hearing Research, ARTORG Center for Biomedical Engineering Research , University of Bern , Bern , Switzerland.
authors.forename: Wilhelm
authors.initials: W
authors.lastname: Wimmer
authors.affiliation: b Image-Guided Therapy and Artificial Hearing Research, ARTORG Center for Biomedical Engineering Research , University of Bern , Bern , Switzerland.
authors.forename: Tom
authors.initials: T
authors.lastname: Williamson
authors.affiliation: b Image-Guided Therapy and Artificial Hearing Research, ARTORG Center for Biomedical Engineering Research , University of Bern , Bern , Switzerland.
authors.forename: Juan
authors.initials: J
authors.lastname: Ansò
authors.affiliation: a Department of ENT, Head and Neck Surgery , Inselspital, Bern University Hospital, University of Bern , Bern , Switzerland.
authors.forename: Georgios
authors.initials: G
authors.lastname: Mantokoudis
authors.affiliation: b Image-Guided Therapy and Artificial Hearing Research, ARTORG Center for Biomedical Engineering Research , University of Bern , Bern , Switzerland.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Gerber
authors.affiliation: b Image-Guided Therapy and Artificial Hearing Research, ARTORG Center for Biomedical Engineering Research , University of Bern , Bern , Switzerland.
authors.forename: Christoph
authors.initials: C
authors.lastname: Rathgeb
authors.affiliation: c Musculoskeletal Biomechanics, Institute for Surgical Technologies and Biomechanics, University of Bern , Bern , Switzerland.
authors.forename: Arne
authors.initials: A
authors.lastname: Feldmann
authors.affiliation: d University Department of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital , Bern , Switzerland.
authors.forename: Franca
authors.initials: F
authors.lastname: Wagner
authors.affiliation: e Department of Neurology , Inselspital, University of Bern , Bern , Switzerland.
authors.forename: Olivier
authors.initials: O
authors.lastname: Scheidegger
authors.affiliation: a Department of ENT, Head and Neck Surgery , Inselspital, Bern University Hospital, University of Bern , Bern , Switzerland.
authors.forename: Martin
authors.initials: M
authors.lastname: Kompis
authors.affiliation: d University Department of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital , Bern , Switzerland.
authors.forename: Christian
authors.initials: C
authors.lastname: Weisstanner
authors.affiliation: f MED-EL Medical Electronics , Innsbruck , Austria.
authors.forename: Masoud
authors.initials: M
authors.lastname: Zoka-Assadi
authors.affiliation: e Department of Neurology , Inselspital, University of Bern , Bern , Switzerland.
authors.forename: Kai
authors.initials: K
authors.lastname: Roesler
authors.affiliation: a Department of ENT, Head and Neck Surgery , Inselspital, Bern University Hospital, University of Bern , Bern , Switzerland.
authors.forename: Lukas
authors.initials: L
authors.lastname: Anschuetz
authors.affiliation: a Department of ENT, Head and Neck Surgery , Inselspital, Bern University Hospital, University of Bern , Bern , Switzerland.
authors.forename: Markus
authors.initials: M
authors.lastname: Huth
authors.affiliation: b Image-Guided Therapy and Artificial Hearing Research, ARTORG Center for Biomedical Engineering Research , University of Bern , Bern , Switzerland.
authors.forename: Stefan
authors.initials: S
authors.lastname: Weber
mesh_terms: D019929:Cochlear Implantation / Q000379:methods*; D005240:Feasibility Studies; D006801:Humans; D012371:Robotics; D014057:Tomography, X-Ray Computed; D057188:Workflow
keywords: Robotic surgery; cochlear implantation; computed tomography imaging; facial nerve monitoring; image guidance; minimally invasive techniques; surgical planning