True keyhole cochlear implant surgery

Abstract

IntroductionMinimal invasive Robotic Assisted Cochlear Implant Surgery (RACIS) is a keyhole surgery by definition. It is therefore not possible to visualize the electrode array during insertion in the scala tympani. Hitherto, surgeons visualised the round window via the external auditory canal by folding over the tympanic membrane. However, the opening of a tympanomeatal flap is not minimal invasive and is especially in conventional cochlear implantation surgery not even necessary. Here we prove that image guided and robot assisted surgery can also allow correct electrode array insertion without opening the tympanomeatal flap. AimThe aim is to report the first experience of robotic cochlear implantation surgery fully based on image guided surgery and without the opening of a tympanomeatal flap for electrode array insertion. InterventionRACIS with a straight flexible lateral wall electrode. Primary outcome measurementsElectrode cochlear insertion depth with RACIS and autonomous inner ear access with full electrode insertion of a flexible lateral wall electrode array. Secondary outcome measurementsThe audiological outcome in terms of mean hearing thresholds. ConclusionAfter a series of 33 cases and after fine-tuning the insertion angles and yet another new version of planning software to depict the round window approach, a new clinical routine for inserting electrodes fully based on image guided surgery without opening a tympanomeatal flap was developed in robotic-assisted cochlear implant surgery.