Van de Heyning Paul, Roland Peter, Lassaletta Luis, Agrawal Sumit, Atlas Marcus, Baumgartner Wolf-Dieter, Brown Kevin, Caversaccio Marco, Dazert Stefan, Gstoettner Wolfgang, Hagen Rudolf, Hagr Abdulrahman, Jablonski Greg Eigner, Kameswaran Mohan, Kuzovkov Vladislav, Leinung Martin, Li Yongxin, Loth Andreas, Magele Astrid, Mlynski Robert, Mueller Joachim, Parnes Lorne, Radeloff Andreas, Raine Chris, Rajan Gunesh, Schmutzhard Joachim, Skarzynski Henryk, Skarzynski Piotr H, Sprinzl Georg, Staecker Hinrich, Stöver Timo, Tavora-Viera Dayse, Topsakal Vedat, Usami Shin-Ichi, Van Rompaey Vincent, Weiss Nora M, Wimmer Wilhelm, Zernotti Mario, Gavilan Javier
Department of Otorhinolaryngology Head and Neck Surgery, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium.
Department of Translational Neurosciences, University of Antwerp, Antwerp, Belgium.
Front Surg. 2022 Mar 24;9:823219. doi: 10.3389/fsurg.2022.823219. eCollection 2022.
The cochlear implant (CI) electrode insertion process is a key step in CI surgery. One of the aims of advances in robotic-assisted CI surgery (RACIS) is to realize better cochlear structure preservation and to precisely control insertion. The aim of this literature review is to gain insight into electrode selection for RACIS by acquiring a thorough knowledge of electrode insertion and related complications from classic CI surgery involving a manual electrode insertion process.
A systematic electronic search of the literature was carried out using PubMed, Scopus, Cochrane, and Web of Science to find relevant literature on electrode tip fold over (ETFO), electrode scalar deviation (ESD), and electrode migration (EM) from both pre-shaped and straight electrode types.
A total of 82 studies that include 8,603 ears implanted with a CI, i.e., pre-shaped (4,869) and straight electrodes (3,734), were evaluated. The rate of ETFO (25 studies, 2,335 ears), ESD (39 studies, 3,073 ears), and EM (18 studies, 3,195 ears) was determined. An incidence rate (±95% CI) of 5.38% (4.4-6.6%) of ETFO, 28.6% (26.6-30.6%) of ESD, and 0.53% (0.2-1.1%) of EM is associated with pre-shaped electrodes, whereas with straight electrodes it was 0.51% (0.1-1.3%), 11% (9.2-13.0%), and 3.2% (2.5-3.95%), respectively. The differences between the pre-shaped and straight electrode types are highly significant ( < 0.001). Laboratory experiments show evidence that robotic insertions of electrodes are less traumatic than manual insertions. The influence of round window (RW) vs. cochleostomy (Coch) was not assessed.
Considering the current electrode designs available and the reported incidence of insertion complications, the use of straight electrodes in RACIS and conventional CI surgery (and manual insertion) appears to be less traumatic to intracochlear structures compared with pre-shaped electrodes. However, EM of straight electrodes should be anticipated. RACIS has the potential to reduce these complications.
人工耳蜗（CI）电极植入过程是CI手术的关键步骤。机器人辅助CI手术（RACIS）进展的目标之一是更好地保留耳蜗结构并精确控制植入。本综述的目的是通过全面了解经典CI手术（涉及手动电极植入过程）中的电极植入及相关并发症，深入了解RACIS中电极的选择。
使用PubMed、Scopus、Cochrane和Web of Science对文献进行系统的电子检索，以查找有关预成型电极和直电极的电极尖端折叠（ETFO）、电极鼓阶偏差（ESD）和电极移位（EM）的相关文献。
共评估了82项研究，包括8603只植入CI的耳朵，即预成型电极（4869只）和直电极（3734只）。确定了ETFO（25项研究，2335只耳朵）、ESD（39项研究，3073只耳朵）和EM（18项研究，3195只耳朵）的发生率。预成型电极的ETFO发生率（±95%CI）为5.38%（4.4 - 6.6%），ESD为28.6%（26.6 - 30.6%），EM为0.53%（0.2 - 1.1%）；而直电极的发生率分别为0.51%（0.1 - 1.3%）、11%（9.2 - 13.0%）和3.2%（2.5 - 3.95%）。预成型电极和直电极类型之间的差异非常显著（<0.001）。实验室实验表明，机器人植入电极比手动植入创伤更小。未评估圆窗（RW）与耳蜗造口术（Coch）的影响。
考虑到现有的电极设计以及报道的植入并发症发生率，与预成型电极相比，在RACIS和传统CI手术（以及手动植入）中使用直电极对耳蜗内结构的创伤似乎更小。然而，应预见到直电极的EM。RACIS有可能减少这些并发症。
