New strategies for high precision surgery of the temporal bone using a robotic approach for cochlear implantation

The aim of the study was to demonstrate a collision-free trajectory of an instrument through the facial recess to the site of planned cochleostomy guided by a surgery robot. The indication for cochlear implantation is still expanding toward more substantial residual hearing. A cochleostomy as atraumatic as possible will influence the preservation of inner ear function. The employment of a highly precise instrument guidance using a robot could represent a feasible solution for a constant reproducible surgical procedure. Screw markers for a point-based registration were fixed on a human temporal bone specimen prepared with a mastoidectomy and posterior tympanotomy. A DICOM dataset has been generated thereof in a 64-multislice computer tomography (CT). A virtual trajectory in a 3D model has been planned representing the path of instrumentation toward the desired spot of cochleostomy. A 1.9-mm endoscope has been mounted onto the robot system RobaCKa (Staeubli RX90CR) to visualize this trajectory. The target registration error added up to 0.25 mm, which met the desirable tolerance of <0.5 mm. A collision-free propagation of the endoscope into the tympanic cavity via the facial recess has been performed by the robot and the spot of cochleostomy could be visualized through the endoscope. Using a DICOM dataset of a high-resolution CT and a robot as a positioning platform for surgical instruments could be a feasible approach to perform a highly precise and constant reproducible cochleostomy. Furthermore, it could be a crucial step to preserve substantial residual hearing in terms of expanding the indications for cochlear implantation.

[1]  R Schrimpf,et al.  Sclerosing lesions of the temporal bone , 1982, The Laryngoscope.

[2]  T. Balkany,et al.  Loss of residual hearing after cochlear implantation , 1989, The Laryngoscope.

[3]  G. M. Clark,et al.  Electrical stimulation of the auditory nerve: The effect of electrode position on neural excitation , 1993, Hearing Research.

[4]  E Lehnhardt,et al.  [Intracochlear placement of cochlear implant electrodes in soft surgery technique]. , 1993, HNO.

[5]  Donald K. Eddington,et al.  Cochlear Implants in Adults and Children , 1995 .

[6]  NIH consensus conference. Cochlear implants in adults and children. , 1995, JAMA.

[7]  [NIH Consensus Conference on cochlear implants in adults and children, 15 to 17 May 1995]. , 1996 .

[8]  N Dillier,et al.  Cochlear implants for adults obtaining marginal benefit from acoustic amplification: a European study. , 1998, The American journal of otology.

[9]  A. Aschendorff,et al.  Cochlear implants and electrical brainstem stimulation in sensorineural hearing loss. , 1999, Current opinion in neurology.

[10]  V Urban,et al.  A tactile feedback hexapod operating robot for endoscopic procedures. , 1999, Neurological research.

[11]  C von Ilberg,et al.  Electric-acoustic stimulation of the auditory system. New technology for severe hearing loss. , 1999, ORL; journal for oto-rhino-laryngology and its related specialties.

[12]  J Stallkamp,et al.  [Applications for a robot in the lateral skull base. Evaluation of robot-assisted mastoidectomy in an anatomic specimen]. , 2001, HNO.

[13]  [Feasibility of inner ear gene transfer after middle ear administration of an adenovirus vector]. , 2001, Laryngo- rhino- otologie.

[14]  J. Stallkamp,et al.  Einsatz eines Roboters an der lateralen Schädelbasis Evaluation einer robotergesteuerten Mastoidektomie am anatomischen Präparat , 2001, HNO.

[15]  Untersuchungen zur durchführbarkeit eines innenohr-gentransfers nach mittelohrapplikation eines adenoviralen vektors , 2001 .

[16]  Jennifer Arcaroli,et al.  The Nucleus® 24 Contour™ Cochlear Implant System: Adult Clinical Trial Results , 2002, Ear and hearing.

[17]  Thomas Lenarz,et al.  Virtual endoscopy of the middle ear: experimental and clinical results of a standardised approach using multi-slice helical computed tomography , 2002, European Radiology.

[18]  Anna Piotrowska,et al.  Preservation of Residual Hearing in Children and Post-Lingually Deafened Adults after Cochlear Implantation: An Initial Study , 2002, ORL.

[19]  T. Lenarz,et al.  Technical Report: Modification of a Cochlear Implant Electrode for Drug Delivery to the Inner Ear , 2003, Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology.

[20]  Heinz Wörn,et al.  Development and First Patient Trial of a Surgical Robot for Complex Trajectory Milling , 2003, Computer aided surgery : official journal of the International Society for Computer Aided Surgery.

[21]  Jan Kiefer,et al.  Conservation of low-frequency hearing in cochlear implantation , 2004, Acta oto-laryngologica.

[22]  Jörg Schipper,et al.  Evaluation des Insertionstraumas des Nucleus® Contour Advance™-Elektrodenträgers im humanen Felsenbeinmodell , 2004 .

[23]  Jan Kiefer,et al.  Hearing preservation in cochlear implantation for electric acoustic stimulation , 2004, Acta oto-laryngologica.

[24]  Thomas Klenzner,et al.  Navigation as a quality management tool in cochlear implant surgery , 2004, The Journal of Laryngology & Otology.

[25]  A Aschendorff,et al.  [Evaluation of the insertion-trauma of the Nucleus Contour Advance electrode-array in a human temporal bone model]. , 2004, Laryngo- rhino- otologie.

[26]  Thomas Klenzner,et al.  Quality Control after Cochlear Implant Surgery by Means of Rotational Tomography , 2005, Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology.

[27]  Michael Tykocinski,et al.  Cochleostomy site: Implications for electrode placement and hearing preservation , 2005, Acta oto-laryngologica.

[28]  Jörg Schipper,et al.  Methodik der Evaluation perimodiolärer CI-Elektrodenträger im Felsenbeinmodell , 2005 .

[29]  A Aschendorff,et al.  [Methods for evaluation of perimodiolar ci electrode arrays in human temporal bones]. , 2005, Laryngo- rhino- otologie.

[30]  Bruce J Gantz,et al.  Preservation of Hearing in Cochlear Implant Surgery: Advantages of Combined Electrical and Acoustical Speech Processing , 2005, The Laryngoscope.

[31]  J. Nadol,et al.  Histopathology of the inner ear relevant to cochlear implantation. , 2006, Advances in oto-rhino-laryngology.

[32]  Thomas Lenarz,et al.  Residual Hearing Conservation and Electroacoustic Stimulation with the Nucleus 24 Contour Advance Cochlear Implant , 2006, Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology.

[33]  Thomas Klenzner,et al.  Quality Control After Insertion of the Nucleus Contour and Contour Advance Electrode in Adults , 2007, Ear and hearing.

[34]  Omid Majdani,et al.  Increase of Accuracy in Intraoperative Navigation Through High-Resolution Flat-Panel Volume Computed Tomography: Experimental Comparison With Multislice Computed Tomography-Based Navigation , 2007, Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology.

[35]  T. Lenarz,et al.  A True Minimally Invasive Approach for Cochlear Implantation: High Accuracy in Cranial Base Navigation Through Flat-Panel-Based Volume Computed Tomography , 2008, Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology.