Improvement of the insertion axis for cochlear implantation with a robot-based system
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It has previously reported that alignment of the insertion axis along the basal turn of the cochlea was depending on surgeon’ experience. In this experimental study, we assessed technological assistances, such as navigation or a robot-based system, to improve the insertion axis during cochlear implantation. A preoperative cone beam CT and a mastoidectomy with a posterior tympanotomy were performed on four temporal bones. The optimal insertion axis was defined as the closest axis to the scala tympani centerline avoiding the facial nerve. A neuronavigation system, a robot assistance prototype, and software allowing a semi-automated alignment of the robot were used to align an insertion tool with an optimal insertion axis. Four procedures were performed and repeated three times in each temporal bone: manual, manual navigation-assisted, robot-based navigation-assisted, and robot-based semi-automated. The angle between the optimal and the insertion tool axis was measured in the four procedures. The error was 8.3° ± 2.82° for the manual procedure (n = 24), 8.6° ± 2.83° for the manual navigation-assisted procedure (n = 24), 5.4° ± 3.91° for the robot-based navigation-assisted procedure (n = 24), and 3.4° ± 1.56° for the robot-based semi-automated procedure (n = 12). A higher accuracy was observed with the semi-automated robot-based technique than manual and manual navigation-assisted (p < 0.01). Combination of a navigation system and a manual insertion does not improve the alignment accuracy due to the lack of friendly user interface. On the contrary, a semi-automated robot-based system reduces both the error and the variability of the alignment with a defined optimal axis.
KeywordsRobot-based insertion Axis improvement Navigation Computer-assisted surgery
We thank Dr. Jean Loup Bensimon for his contribution to the cone beam CT acquisition used in this work.
Compliance with ethical standards
This work was supported by research funding by Cifre Grant (No. 269/2015 ANRT/Oticon Medical) and Agir pour l’Audition Fundation (Grant No. 2014/GRE/LL/HB/028-U867)
Conflict of interest
The authors indicate no potential conflict of interest.
This article does not contain any studies with human participants performed by any of the authors.
Video 1. Insertion axis planning. This is a 3D surface model of the temporal bone from the cone beam CT slides. The 3D reconstruction of the temporal bone corresponding to Figure 1. We can see a panoramic view of the mastoidectomy hole, the posterior tympanotomy, and the fiducial markers at the cortical bone around the mastoidectomy. Then, it appears a vector corresponding to the scala tympani centerline, we can see that this axis passes through the facial canal position and we cannot access directly to the entry point with the insertion tool. Then, the optimal insertion axis was defined and passes through the posterior tympanotomy (MP4 53761 kb)
Video 2. Insertion tool position assessment. At the end of the alignment, there was obtained 70 photographs of the temporal bone surface and the real position of the insertion tool. Then, a 3D surface model was made by photogrammetry; in this model, we have the axis of the insertion tool at the end of the procedure. Here, we can see a 3D surface model obtained from the cone beam CT and there was added the optimal insertion axis. At last, we can see the fusion of both 3D models and we can observe the real position of the insertion tool at the end of the procedure (green line) corresponding to the optimal insertion axis (MP4 105862 kb)
Video 3. Semi-automated alignment. We observe the semi-automated procedure. Both the insertion tool and the temporal bone were tightly attached to a neuronavigation emitter. A pedal activated the semi-automated movement of the robot arm to align the insertion tool to the optimal insertion axis and to place the insertion tool tip at the entry point to the cochlea (MP4 38593 kb)
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