Auinger Alice Barbara, Dahm Valerie, Liepins Rudolfs, Riss Dominik, Baumgartner Wolf-Dieter, Arnoldner Christoph
Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria.
Front Surg. 2021 Sep 29;8:742219. doi: 10.3389/fsurg.2021.742219. eCollection 2021.
Robotic surgery has been proposed in various surgical fields to reduce recovery time, scarring, and to improve patients' outcomes. Such innovations are ever-growing and have now reached the field of cochlear implantation. To implement robotic ear surgery in routine, it is of interest if preoperative planning of a safe trajectory to the middle ear is possible with clinically available image data. We evaluated the feasibility of robotic cochlear implant surgery in 50 patients (100 ears) scheduled for routine cochlear implant procedures based on clinically available imaging. The primary objective was to assess if available high-resolution computed tomography or cone beam tomography imaging is sufficient for planning a trajectory by an otological software. Secondary objectives were to assess the feasibility of cochlear implant surgery with a drill bit diameter of 1.8 mm, which is the currently used as a standard drill bit. Furthermore, it was evaluated if feasibility of robotic surgery could be increased when using smaller drill bit sizes. Cochlear and trajectory parameters of successfully planned ears were collected. Measurements were carried out by two observers and the interrater reliability was assessed using Cohen's Kappa. Under the prerequisite of the available image data being sufficient for the planning of the procedure, up to two thirds of ears were eligible for robotic cochlear implant surgery with the standard drill bit size of 1.8 mm. The main reason for inability to plan the keyhole access was insufficient image resolution causing anatomical landmarks not being accurately identified. Although currently not applicable in robotic cochlear implantation, narrower drill bit sizes ranging from 1.0 to 1.7 mm in diameter could increase feasibility up to 100%. The interrater agreement between the two observers was good for this data set. For robotic cochlear implant surgery, imaging with sufficient resolution is essential for preoperative assessment. A slice thickness of <0.3 mm is necessary for trajectory planning. This can be achieved by using digital volume tomography while radiation exposure can be kept to a minimum. Furthermore, surgeons who use the software tool, should be trained on a regular basis in order to achieve planning consistency.
机器人手术已被应用于各个外科领域，以缩短恢复时间、减少疤痕并改善患者预后。此类创新不断发展，现已进入人工耳蜗植入领域。要将机器人耳部手术常规化，如果利用临床可用图像数据能够对中耳的安全手术路径进行术前规划，那将是很有意义的。我们基于临床可用成像技术，对50例（100耳）计划进行常规人工耳蜗植入手术的患者评估了机器人人工耳蜗植入手术的可行性。主要目的是评估可用的高分辨率计算机断层扫描或锥形束断层扫描成像是否足以通过耳科软件规划手术路径。次要目的是评估直径为1.8毫米的钻头（目前用作标准钻头）进行人工耳蜗植入手术的可行性。此外，还评估了使用更小直径钻头时是否能提高机器人手术的可行性。收集了成功规划手术路径的耳朵的耳蜗和手术路径参数。由两名观察者进行测量，并使用科恩卡方检验评估评分者间的可靠性。在可用图像数据足以进行手术规划的前提下，高达三分之二的耳朵适合使用1.8毫米标准钻头进行机器人人工耳蜗植入手术。无法规划锁孔入路的主要原因是图像分辨率不足，导致解剖标志无法准确识别。虽然目前在机器人人工耳蜗植入中不适用，但直径在1.0至1.7毫米之间的更窄钻头尺寸可将可行性提高至100%。对于该数据集，两名观察者之间的评分者间一致性良好。对于机器人人工耳蜗植入手术，具有足够分辨率的成像对于术前评估至关重要。轨迹规划需要切片厚度<0.3毫米。这可以通过使用数字容积断层扫描来实现，同时可将辐射暴露保持在最低水平。此外，使用该软件工具的外科医生应定期接受培训，以实现规划的一致性。
