Abstract
The HEARO cochlear implantation surgery aims to replace the conventional wide mastoidectomy approach with a minimally invasive direct cochlear access. The main advantage of the HEARO access would be that the trajectory accommodates the optimal and individualized insertion parameters such as type of cochlear access and trajectory angles into the cochlea. To investigate the quality of electrode insertion with the HEARO procedure, the insertion process was inspected under fluoroscopy in 16 human cadaver temporal bones. Prior to the insertion, the robotic middle and inner ear access were performed through the HEARO procedures. The status of the insertion was analyzed on the post-operative image with Siemens Artis Pheno (Siemens AG, Munich, Germany). The completion of the full HEARO procedure, including the robotic inner ear access and fluoroscopy electrode insertion, was possible in all 16 cases. It was possible to insert the electrode in all 16 cases through the drilled tunnel. However, one case in which the full cochlea was not visible on the post-operative image for analysis was excluded. The post-operative analysis of the electrode insertion showed an average insertion angle of 507°, which is equivalent to 1.4 turns of the cochlea, and minimal and maximal insertion angles were recorded as 373° (1 cochlear turn) and 645° (1.8 cochlear turn), respectively. The fluoroscopy inspection indicated no sign of complications during the insertion.
Highlights
Cochlear implantation has been the gold standard treatment for severe to profound sensorineural hearing loss over several decades [1]
There was no damage to the ossicles
It was possible to insert the electrode in all 16 cases through the drilled tunnel after the robotic inner ear access under the fluoroscopy guidance
Summary
Cochlear implantation has been the gold standard treatment for severe to profound sensorineural hearing loss over several decades [1]. This conventional surgical method is well established and practiced in many countries; its success relies on the surgical skills and on the anatomical variations in the patient. To overcome these variables, the development of robotic cochlear implantation took place. Caversaccio [2], Labadie [3], and Bell [4] have previously described the safety and success of this procedure; their experience with robotic assisted surgery was limited to the middle ear access and not to the inner ear
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