Human Kinematics of Cochlear Implant Surgery: An Investigation of Insertion Micro-Motions and Speed Limitations.

Abstract

Objectives Document human motions associated with cochlear implant electrode insertion at different speeds and determine the lower limit of continuous insertion speed by a human. Study Design Observational. Setting Academic medical center. Subjects and Methods Cochlear implant forceps were coupled to a frame containing reflective fiducials, which enabled optical tracking of the forceps' tip position in real time. Otolaryngologists (n = 14) performed mock electrode insertions at different speeds based on recommendations from the literature: "fast" (96 mm/min), "stable" (as slow as possible without stopping), and "slow" (15 mm/min). For each insertion, the following metrics were calculated from the tracked position data: percentage of time at prescribed speed, percentage of time the surgeon stopped moving forward, and number of direction reversals (ie, going from forward to backward motion). Results Fast insertion trials resulted in better adherence to the prescribed speed (45.4% of the overall time), no motion interruptions, and no reversals, as compared with slow insertions (18.6% of time at prescribed speed, 15.7% stopped time, and an average of 18.6 reversals per trial). These differences were statistically significant for all metrics ( P < .01). The metrics for the fast and stable insertions were comparable; however, stable insertions were performed 44% slower on average. The mean stable insertion speed was 52 ± 19.3 mm/min. Conclusion Results indicate that continuous insertion of a cochlear implant electrode at 15 mm/min is not feasible for human operators. The lower limit of continuous forward insertion is 52 mm/min on average. Guidelines on manual insertion kinematics should consider this practical limit of human motion.