Initial Surgeon Experiences With a Robotic-Assisted Cochlear Implant Electrode Array Insertion System

Abstract

Objective: To assess integration of a single-use robotic-assisted cochlear implant (RA-CI) electrode array insertion system into surgical workflows, identify potential challenges, and inform best practices.

Study design: Survey.

Setting: Survey data from 16 surgeons across 10 US hospitals.

Patients: CI candidates 12 years and older with radiographically normal cochleae.

Intervention: CI surgery with single-use RA-CI insertion system during electrode array insertion.

Main outcome measures: Number of RA-CI to achieve proficiency, estimated additional time for RA-CI, and best practices to successfully incorporate the RA insertion system into CI surgery.

Results: A total of 121 RA-CI cases were performed. All surgeons completed the survey. Most surgeons (62.5%) reported they would feel comfortable using the device within five cases. Eight (50%) reported use of the RA system added 5 to 10 minutes to the case, and seven (44%) reported an added 10-15 minutes. Providing adequate incision size to secure the unit base superior to the temporal line and maximizing exposure of the facial recess were the most recommended best practices. Additional recommendations included pulling the receiver/stimulator forward within the pocket to facilitate a full electrode array insertion and considering drive head placement and mastoidectomy size to maximize overall visibility during electrode array insertion.

Conclusions: Proficiency with an RA electrode array insertion system during CI surgery can be achieved with minor adjustments to the surgical approach, within relatively few use cases (generally <5) and with minimal time addition (between 5 and 15 min). Training to specific best practices is important before initial clinical use.

Keywords: Cochlear implant; Cochlear implantation; Electrode array insertion; Hearing preservation; Robotic; Robotic-assisted; Robotics-assisted; Soft surgery.