Workflow assessment as a preclinical development tool
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Minimally invasive cochlear implant surgery is a challenging procedure due to high demands on accuracy. For clinical success, an according assistance system has to compete against the traditional approach in terms of risk, operating time and cost. It has not yet been determined what kind of system is the most suited. The purpose of this study is a proof of concept of surgical process modeling as a preclinical development tool and the comparison of workflow concepts for this new approach.
Three preclinical systems (two stereotactic and one robotic) for minimally invasive cochlear implant surgery are compared using the method of surgical process modeling. All three systems were successfully tested with ex vivo human specimen to create minimally invasive surgical access to the cochlea. Those systems where chosen for comparison, because they represent three diverse approaches with different corresponding workflows for the same intervention. The experiments were used to create a process model for each system by recording the interventions.
All three conceptual systems developed by our group have shown their eligibility. The recorded process models provide a convenient method for direct comparison. Reduction in the surgical time has a higher impact on the process, than time that is needed for setting up a system beforehand. The stereotactic approaches have little preparation effort and are low cost in terms of hardware compared to the robotic approach, which in return is beneficial in terms of workload reduction for the surgeon.
Surgical process modeling is suitable for comparison of different assistant systems for minimally invasive cochlear implantation. The benefit of reduced trauma, compared to the traditional mastoidectomy, can now be assessed with consideration of the workflow of each technique. The process models enable an assessment in the regard of surgical time and workload.
KeywordsSurgical process model Minimally invasive surgery Cochlear implant Surgical robotics System evaluation
The authors acknowledge the financial support by the Federal Ministry of Education and Research of Germany (BMBF Project Numbers 13GW0019C and 13GW0019E).
Compliance with ethical standards
Conflict of interest
The authors Tobias Ortmaier, Marcel Kluge, Samuel John, Thomas Rau, Omid Majdani and Thomas Lenarz declare being limited partners of HörSys IP GmbH & Co. KG that holds intellectual property regarding the RoboJigTM technology.
This article does not contain any studies with human participants or animals performed by any of the authors.
This articles does not contain patient data.
- 1.National Institues of Health (2010) Cochlear implants https://report.nih.gov/NIHfactsheets/ Pdfs/CochlearImplants(NIDCD).pdf. Accessed 12 Dec 2017 [Online]
- 2.World Health Organization, WHO (2017) Deafness and hearing loss http://www.who.int/mediacentre/factsheets/fs300/en/. Accessed 12 Dec 2017 [Online]
- 4.Kobler JP, Kotlarski J, Lexow GJ, Rau TS, Majdani O, Ortmaier T (2014) Design optimization of a bone-attached, redundant and reconfigurable parallel kinematic device for skull surgery. In: IEEE international conference on robotics and automation (ICRA), pp 2364–2371Google Scholar
- 7.Kratchman LB, Blachon GS, Withrow TJ, Balachandran R, Labadie RF, Webster RJ (2010) Toward automation of image-guided microstereotactic frames: a bone-attached parallel robot for percutaneous cochlear implantation. Robot Sci Syst Workshop Enabling Technol 31:94–99Google Scholar
- 10.Labadie RF, Balachandran R, Noble JH, Blachon GS, Mitchell JE, Reda FA, Dawant BM, Fitzpatrick JM (2014) Minimally invasive image-guided cochlear implantation surgery: first report of clinical implementation the laryngoscope. Am Laryngol Rhinol Otol Soc 124:1915–1922Google Scholar
- 11.Vollmann B, Müller S, Kundrat D, Ortmaier T, Kahrs LA (2015) Methods for intraoperative, sterile pose-setting of patient-specific microstereotactic frames. In: Proceedings of SPIE, vol 9415, pp 94150M–94157Google Scholar
- 12.Rau TS, Lexow GJ, Blume D, Kluge M, Lenarz T, Majdani O (2017) Micro-stereotactic frame utilizing bone cement for individual fabrication: an initial investigation of its accuracy. In: Proc SPIE, vol 10135, p 10135–10139Google Scholar
- 16.Weber S, Gavaghan K, Wimmer W, Williamson T, Gerber N, Anso J, Bell B, Feldmann A, Rathgeb C, Matulic M, Stebinger M, Schneider D, Mantokoudis G, Scheidegger O, Wagner F, Kompis M, Caversaccio M (2017) Instrument flight to the inner ear. Sci Robot 2(eaal491):6Google Scholar
- 18.Dahroug B, Tamadazte B, Tavernier L, Weber S, Andreff N (2018) Review on otological robotic systems: toward micro-robot assisted cholesteatoma surgery. In: IEEE reviews in biomedical engineering, early access, ahead of printGoogle Scholar
- 19.Ansó J, Wimmer W, Rathgeb C, Gerber N, Schneider D, Hermann J, Williamson T, Mantokoudis G, Caversaccio M, Weber S, Gavaghan K (2017) Robotic cochlear implantation—first clinical experiences. In: Proceedings of 16th annual meeting of the German society for computer and robot assisted surgery, CURAC 2017, pp 144–150Google Scholar
- 24.Neumuth T (2016) Surgical process modeling. Innov Surg Sci 2:123–137Google Scholar
- 28.Neumuth T, Schumann S, Strauß G, Jannin P, Meixensberger J, Dietz A, Lemke HU, Burgert O (2006) Visualization options for surgical workflows. Int J Comput Assist Radiol Surg 1:438–440Google Scholar
- 31.Schneider V, Mueller S, Nuelle K, Kahrs LA, Majdani O, Ortmaier T (2017) Experimental accuracy optimization of a parallel kinematic tool for minimally invasive cochlear-implant surgery. In: Proceedings of 16th annual meeting of the German society for computer and robot assisted surgery, CURAC 2017, pp 202–207Google Scholar