Synchrotron-Based Trauma Assessment of Robotic Electrode Insertions in Cochlear Implantation.

objectivesMinimizing intraoperative trauma during cochlear implant electrode insertion is crucial for preserving residual hearing. Manual insertions are subject to variability due to surgeon experience and anatomical differences, often leading to inconsistent outcomes. Robotic-assisted systems have been developed to improve insertion precision and reduce trauma. This study evaluates the safety and efficacy of the OTODRIVE system for cochlear implant electrode insertion.

methodsFifteen cadaveric human temporal bones were implanted with a variety of electrodes (FLEX26, FLEX28, FLEXSOFT, FLEX34) and an inner ear catheter (INCAT). The OTODRIVE system was used to maintain a constant insertion speed of 0.1 mm/s. The samples were subsequently imaged using synchrotron radiation phase-contrast imaging (SR-PCI) to assess intracochlear trauma. Parameters such as linear and angular insertion depths and cochlear coverage were measured. The presence of trauma was analyzed using a trauma evaluation plot.

resultsThe average linear insertion depth was 24.8 ± 3.5 mm, and the average angular insertion depth was 527° ± 81°. Cochlear coverage was 74% ± 7%. Only one case of partial scala media translocation and two cases of basilar membrane elevation were observed, with no instances of severe trauma such as tip fold-over, scala vestibuli translocation, or osseous spiral lamina fracture.

conclusionThe findings indicate that the OTODRIVE system enables consistent and controlled electrode placement while minimizing trauma to cochlear structures, suggesting its potential to enhance hearing and structural preservation outcomes. Further clinical studies are required to establish the long-term benefits of robotic-assisted techniques over manual insertions in routine cochlear implantation. LEVEL OF EVIDENCE: N/A.