Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium.
Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium.
Sci Rep. 2024 Nov 18;14(1):28426. doi: 10.1038/s41598-024-79722-3.
The aim of robot-assisted cochlear implant surgery (RACIS) is to access the inner ear with minimal trauma. High-resolution imaging, empowered with a highly accurate navigation system can enable the planning of a direct keyhole drilling trajectory toward the inner ear. The time has come to (re)define the ideal trajectory into the inner ear with robot-assisted tools that can drill with the highest accuracy. The trajectories of past RACIS procedures were analysed to gain insight into how to calculate the most ideal trajectory and to determine which trajectory parameters influence the course of the procedure. Data-analysis was performed on three groups of previously performed RACIS-procedures. Group 1 included the RACIS-procedures with a round window (RW) approach. Group 2 included the RACIS-procedures with difficulty entering the inner ear. Group 3 included the converted cases to conventional CI surgery due to inadequate intra-operative safety margins. The RW diameter was significantly smaller and its orientation significantly less favourable in group 2 compared to group 1. A smaller surface size and an unfavourable orientation of the RW in relation to the drilling trajectory are thus associated with a more difficult electrode array insertion in RACIS. Both must be taken into account when planning a drilling trajectory into the inner ear.
机器人辅助人工耳蜗植入手术（RACIS）的目的是在内耳手术中实现最小的创伤。高分辨率成像技术与高精度导航系统相结合，可以规划直接通向内耳的微创钻孔轨迹。现在是时候利用机器人辅助工具重新定义进入内耳的理想轨迹，以实现最高精度的钻孔。对过去的 RACIS 手术轨迹进行分析，以深入了解如何计算最理想的轨迹，并确定哪些轨迹参数会影响手术过程。对三组之前进行的 RACIS 手术进行数据分析。第 1 组包括经圆窗（RW）入路的 RACIS 手术；第 2 组包括难以进入内耳的 RACIS 手术；第 3 组包括由于术中安全裕度不足而转为传统 CI 手术的病例。与第 1 组相比，第 2 组的 RW 直径更小，方向也更不利。因此，RW 的表面积较小，与钻孔轨迹的方向不利，与 RACIS 中更困难的电极阵列插入相关。在规划进入内耳的钻孔轨迹时，这两点都必须考虑在内。
