Instrument flight to the inner ear

Image-guided robotic surgery, designed for operating on small structures, is demonstrated for robotic cochlear implantation. Surgical robot systems can work beyond the limits of human perception, dexterity, and scale, making them inherently suitable for use in microsurgical procedures. However, despite extensive research, image-guided robotics applications for microsurgery have seen limited introduction into clinical care to date. Among others, challenges are geometric scale and haptic resolution at which the surgeon cannot sufficiently control a device outside the range of human faculties. Mechanisms are required to ascertain redundant control on process variables that ensure safety of the device, much like instrument flight in avionics. Cochlear implantation surgery is a microsurgical procedure, in which specific tasks are at submillimetric scale and exceed reliable visuo-tactile feedback. Cochlear implantation is subject to intra- and interoperative variations, leading to potentially inconsistent clinical and audiological outcomes for patients. The concept of robotic cochlear implantation aims to increase consistency of surgical outcomes, such as preservation of residual hearing, and to reduce invasiveness of the procedure. We report successful image-guided, robotic cochlear implantation in human. The robotic treatment model encompasses computer-assisted surgery planning, precision stereotactic image guidance, in situ assessment of tissue properties, and multipolar neuromonitoring, all based on in vitro, in vivo, and pilot data. The model is expandable to integrate additional robotic functionalities such as cochlear access and electrode insertion. Our results demonstrate the feasibility and possibilities of using robotic technology for microsurgery on the lateral skull base. It has the potential for benefit in other microsurgical domains for which there is no task-oriented robotic technology available at present.