Coulson C J, Assadi M Zoka, Taylor R P, Du X, Brett P N, Reid A P, Proops D W
ENT Department, Queen Elizabeth Hospital, Edgbaston, Birmingham B15 2TH, UK.
Cochlear Implants Int. 2013 Mar;14(2):98-106. doi: 10.1179/1754762811Y.0000000018. Epub 2011 Sep 24.
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.
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.
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.
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.
蜗窗造瘘术是人工耳蜗植入手术的关键步骤。在这一步骤中尽量减少耳蜗受到的创伤被认为是听力保留型人工耳蜗植入的一个关键特征。本文的目的，一是评估手动和机器人辅助蜗窗造瘘术过程中对耳蜗的干扰；二是确定在人类人工耳蜗植入过程中使用智能微型钻头是否可行。
通过在猪标本的耳蜗基底转前侧创建第三个窗口蜗窗造瘘术并保留其下方的骨内膜，分析蜗窗造瘘术过程中耳蜗内的干扰情况。将激光振动计对准这个第三个窗口，在进行传统蜗窗造瘘术时评估其运动。总共进行了6次蜗窗造瘘术，3次手动操作，3次使用智能微型钻头。计算手动和智能微型钻头操作组的平均和峰值膜运动，以代表蜗窗造瘘术形成过程中耳蜗内受到的干扰。智能微型钻头还被用于对三名符合英国国家卫生与临床优化研究所人工耳蜗植入标准的成年患者进行实时人体机器人蜗窗造瘘术。
在猪实验中，智能微型钻头在所有三个病例中均保留了骨内膜。手动蜗窗造瘘术期间骨内膜的平均运动速度约为机器人辅助蜗窗造瘘术的20倍，峰值速度则高出100倍。在所有三个病例中，机器人均在手术室中安全使用，并成功创建了骨性蜗窗造瘘术，同时保留了下方的骨内膜。
我们的实验表明，在蜗窗造瘘术形成过程中控制钻孔力并用骨膜剥离器打开骨内膜，可将耳蜗受到的创伤减少20倍。此外，智能微型钻头可以在手术条件下安全地对人体进行骨性蜗窗造瘘术，并保留下方骨内膜的完整性。
