Aebischer Philipp, Anschuetz Lukas, Caversaccio Marco, Mantokoudis Georgios, Weder Stefan
Hearing Research Laboratory, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, 3008, Switzerland.
Department for Otolaryngology, Head and Neck Surgery, Inselspital University Hospital Bern, 3010, Bern, Switzerland.
Int J Comput Assist Radiol Surg. 2025 Feb;20(2):323-332. doi: 10.1007/s11548-024-03276-y. Epub 2024 Oct 1.
As an increasing number of cochlear implant candidates exhibit residual inner ear function, hearing preservation strategies during implant insertion are gaining importance. Manual implantation is known to induce traumatic force and pressure peaks. In this study, we use a validated in-vitro model to comprehensively evaluate a novel surgical tool that addresses these challenges through motorized movement of a forceps.
Using lateral wall electrodes, we examined two subgroups of insertions: 30 insertions were performed manually by experienced surgeons, and another 30 insertions were conducted with a robot-assisted system under the same surgeons' supervision. We utilized a realistic, validated model of the temporal bone. This model accurately reproduces intracochlear frictional conditions and allows for the synchronous recording of forces on intracochlear structures, intracochlear pressure, and the position and deformation of the electrode array within the scala tympani.
We identified a significant reduction in force variation during robot-assisted insertions compared to the conventional procedure, with average values of 12 mN/s and 32 mN/s, respectively. Robotic assistance was also associated with a significant reduction of strong pressure peaks and a 17 dB reduction in intracochlear pressure levels. Furthermore, our study highlights that the release of the insertion tool represents a critical phase requiring surgical training.
Robotic assistance demonstrated more consistent insertion speeds compared to manual techniques. Its use can significantly reduce factors associated with intracochlear trauma, highlighting its potential for improved hearing preservation. Finally, the system does not mitigate the impact of subsequent surgical steps like electrode cable routing and cochlear access sealing, pointing to areas in need of further research.
随着越来越多的人工耳蜗植入候选者表现出残余内耳功能，植入过程中的听力保护策略变得越发重要。已知手动植入会产生创伤性力和压力峰值。在本研究中，我们使用经过验证的体外模型全面评估一种新型手术工具，该工具通过镊子的电动移动来应对这些挑战。
使用侧壁电极，我们检查了两个植入亚组：30次植入由经验丰富的外科医生手动进行，另外30次植入在同一位外科医生的监督下使用机器人辅助系统进行。我们利用了一个逼真的、经过验证的颞骨模型。该模型准确再现了耳蜗内的摩擦条件，并允许同步记录耳蜗内结构上的力、耳蜗内压力以及电极阵列在鼓阶内的位置和变形。
我们发现与传统手术相比，机器人辅助植入过程中的力变化显著降低，平均值分别为12 mN/s和32 mN/s。机器人辅助还与强压力峰值的显著降低以及耳蜗内压力水平降低17 dB相关。此外，我们的研究强调插入工具的释放是一个需要手术训练的关键阶段。
与手动技术相比，机器人辅助显示出更一致的插入速度。其使用可显著减少与耳蜗内创伤相关的因素，突出了其在改善听力保护方面的潜力。最后，该系统并未减轻后续手术步骤（如电极电缆布线和耳蜗入口密封）的影响，指出了需要进一步研究的领域。
