Learning Objectives: Robot assited cochlear implantation.

Background: Cochlear implantation has become the treatment of choice for patients with severe to profound sensory hearing loss. An increasing percentage of patients show up with residual hearing which should be preserved during and after surgery. In order to improve the precision of electrode insertion with respect to individual cochlear anatomy and existing hearing loss, an advanced concept of robot assisted cochlear implantation has been developed.

Method: The stereotactic frame robotic system has been developed to allow for minimal invasive high precision cochlear implantation. Using preoperative CT data and a tripod stereotactic frame it is possible to calculate precisely the optimal trajectory from the surface of the mastoid to the inner ear. This path can then be drilled with help of a disposable drilling jig that , which has been individualized to the planned trajectory with an intraoperative robotic assistance system and it has been validated in temporal bone and surgeon studies prior to planned first in man applications.

Results: The overall accuracy is better than 0.5 millimeter. Injuries to facial nerve and scala tympani can be avoided with high probability. The exact placement of the electrode in the scala tympani was achieved.

Conclusion: Robot assisted ear surgery, especially cochlear implantation is both feasible and possible. Introducing such a system would decrease the time needed for implantation by half. The system is easy to use with minimal requirements in terms of technology. It can be adapted for a wide range of auditory implants.