Clin Exp Otorhinolaryngol.  2025 Feb;18(1):21-29. 10.21053/ceo.2024.00253.

Robotic Versus Manual Electrode Insertion in Cochlear Implant Surgery: An Experimental Study

• Alhabib SF
• Alzhrani F
• Alsanosi A
• Al-Amro M
• Alballaa A
• Shami I
• Hagr A
• Alahmadi A
• Sharif T
• Stichling M
• Matulic M
• Assadi MZ
• Abdelsamad Y
• Almuhawas F

• KMID: 2565230
• DOI: http://doi.org/10.21053/ceo.2024.00253

Abstract

Objectives
. This experimental study compared the precision and surgical outcomes of manual versus robotic electrode insertions in cochlear implantation.
Methods
. The study was conducted on formalin-fixed cadaveric heads, with nine senior neurotologists performing both manual and robotic insertions.
Results
. The results showed no statistically significant differences between the two methods in terms of insertion angle, cochlear coverage, or electrode coverage. However, the robotic method demonstrated a significantly slower and more controlled insertion speed (0.1 mm/sec) compared to manual insertion (0.66±0.31 mm/sec), which is crucial for minimizing intra-cochlear force and pressures. Although robotic insertions resulted in fewer complications such as tip fold-over or scala deviation, there were instances of incomplete insertion.
Conclusion
. The robotic system provided a consistent and controlled insertion process, potentially standardizing cochlear implant operations and reducing outcome variability. The study concludes that robotic-assisted insertion offers significant advantages in controlling insertion speed and consistency, supporting the continued development and clinical evaluation of robotic systems for cochlear implant surgery.

Keyword

Cochlear Implantation; Robotic Insertion; Manual Insertion; Robotic Cochlear Implantation; Electrode Coverage

Figure

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  Fig. 1. Schematic overview of the set-up, including the OTODRIVE, Forceps OD, Connector OD, OTOARM Aligner, and OTOARM.

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  Fig. 2. (A) The robotic insertion setup. (B) The electrode is inserted through the round window using OTODRIVE.

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  Fig. 3. Postoperative analysis of case 7L using the OTOPLAN software. Insertion status of the electrode array inside the three-dimensional reconstruction of the full cochlea in red (A) and scala tympani in purple (B). CC, center of cochlea; CRW, center of the round window; L, left.

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  Fig. 4. Postoperative insertion angle (A), cochlear coverage (B), and electrode coverage (C) between the manual and robotic techniques. The solid gray line represents the mean for each group.

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  Fig. 5. Preoperative estimation and postoperative actual C1 insertion angle for manual (A) and robotic (B) insertions. The cases with insertion complications are marked by a specific symbol. L, left; R, right.

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