Next-generation Robotics in Otology: The HEARO Procedure

BACKGROUND: In a world that is globalizing and centered on rapid communication, hearing impairment is one of the most common disabilities. The most effective and successful neural prosthesis in humans for treating the dysfunction of a sensory organ is cochlear implantation. The minimally invasive placement of the array in the cochlea should warrant the rehabilitation of profound hearing loss over all frequencies. Some key factors for structure and hearing preservation consist of minimal invasive drilling in the temporal bone and tailored inner ear access. Next-generation Robotically Assisted Cochlear Implantation Surgery (RACIS) focuses on robotic inner ear access. The purpose of this cadaveric preclinical study was to assess the viability and precision of a novel technology (the HEARO method) for RACIS, or more particularly, personalized robotic inner ear access. METHODS: The external auditory canal, chorda tympani, ossicles, facial nerve, and other pertinent anatomical components were all 3-dimensional (3D)-reconstructed by the surgeon. The mean intended distance and drilling trajectory to the chorda tympani and facial nerve were, respectively, 0.44±0.13 and 0.35±0.27 mm. RESULTS: With a mean insertion percentage of 94%, the surgeon was able to complete the HEARO method in 9 out of 10 procedures. There was no evidence of a collision or damage to vital structures. CONCLUSION: Future iterations of RACIS will prioritize haptic feedback, automated segmentation and trajectory, robotic insertion with adjustable speed, and imaging mobile cone beam computed tomography.