Department of Computer Science, The Johns Hopkins University, Baltimore, Maryland2Intuitive Surgical, Inc, Sunnyvale, California.
Intuitive Surgical, Inc, Sunnyvale, California.
JAMA Otolaryngol Head Neck Surg. 2014 Mar;140(3):208-14. doi: 10.1001/jamaoto.2013.6443.
To our knowledge, this is the first reported cadaveric feasibility study of a master-slave-assisted cochlear implant procedure in the otolaryngology-head and neck surgery field using the da Vinci Si system (da Vinci Surgical System; Intuitive Surgical, Inc). We describe the surgical workflow adaptations using a minimally invasive system and image guidance integrating intraoperative cone beam computed tomography through augmented reality.
To test the feasibility of da Vinci Si-assisted cochlear implant surgery with augmented reality, with visualization of critical structures and facilitation with precise cochleostomy for electrode insertion.
Cadaveric case study of bilateral cochlear implant approaches conducted at Intuitive Surgical Inc, Sunnyvale, California.
Bilateral cadaveric mastoidectomies, posterior tympanostomies, and cochleostomies were performed using the da Vinci Si system on a single adult human donor cadaveric specimen.
Radiographic confirmation of successful cochleostomies, placement of a phantom cochlear implant wire, and visual confirmation of critical anatomic structures (facial nerve, cochlea, and round window) in augmented stereoendoscopy.
With a surgical mean time of 160 minutes per side, complete bilateral cochlear implant procedures were successfully performed with no violation of critical structures, notably the facial nerve, chorda tympani, sigmoid sinus, dura, or ossicles. Augmented reality image overlay of the facial nerve, round window position, and basal turn of the cochlea was precise. Postoperative cone beam computed tomography scans confirmed successful placement of the phantom implant electrode array into the basal turn of the cochlea.
To our knowledge, this is the first study in the otolaryngology-head and neck surgery literature examining the use of master-slave-assisted cochleostomy with augmented reality for cochlear implants using the da Vinci Si system. The described system for cochleostomy has the potential to improve the surgeon's confidence, as well as surgical safety, efficiency, and precision by filtering tremor. The integration of augmented reality may be valuable for surgeons dealing with complex cases of congenital anatomic abnormality, for revision cochlear implant with distorted anatomy and poorly pneumatized mastoids, and as a method of interactive teaching. Further research into the cost-benefit ratio of da Vinci Si-assisted otologic surgery, as well as refinements of the proposed workflow, are required before considering clinical studies.
据我们所知，这是首次在耳鼻喉头颈外科学领域使用达芬奇 Si 系统（达芬奇手术系统；直观外科公司）报告的主从辅助人工耳蜗植入术的尸体可行性研究。我们描述了使用微创系统和术中锥形束计算机断层扫描与增强现实相结合的图像引导的手术工作流程适应。
测试达芬奇 Si 辅助人工耳蜗手术与增强现实的可行性，实现关键结构的可视化，并通过精确的耳蜗造口术促进电极插入。
在加利福尼亚州森尼韦尔的直观外科公司进行的双侧人工耳蜗植入方法的尸体案例研究。
在单个成人尸体标本上使用达芬奇 Si 系统进行双侧尸体乳突切除术、后鼓室切开术和耳蜗造口术。
成功耳蜗造口术的放射照相确认、放置人工耳蜗线的幻影和增强立体内窥镜中关键解剖结构（面神经、耳蜗和圆窗）的视觉确认。
每侧手术平均时间为 160 分钟，成功完成了双侧人工耳蜗植入手术，没有侵犯关键结构，特别是面神经、鼓索、乙状窦、硬脑膜或听小骨。面神经、圆窗位置和面神经基底转的增强现实图像叠加非常精确。术后锥形束计算机断层扫描确认成功将幻影植入电极阵列放置在耳蜗基底转。
据我们所知，这是耳鼻喉头颈外科学文献中首次研究使用达芬奇 Si 系统的主从辅助耳蜗造口术与增强现实进行人工耳蜗植入。所描述的耳蜗造口术系统有可能通过过滤震颤来提高外科医生的信心，以及手术的安全性、效率和精度。增强现实的集成对于处理复杂的先天性解剖异常病例、解剖扭曲和未充气乳突的修正性人工耳蜗植入以及作为一种交互式教学方法的外科医生可能具有价值。在考虑临床研究之前，需要进一步研究达芬奇 Si 辅助耳科手术的成本效益比，以及对拟议工作流程的改进。
