Robot-assisted cochlear implant electrode insertion may be feasible and demonstrate a favorable safety profile.
In the retrospective descriptive study, investigators evaluated 50 consecutive adult patients who underwent cochlear implantation using the Otoarm-Otodrive system at a tertiary referral otology center in Canada between January and October 2025. The cohort included 14 patients (28%) with single-sided deafness and 36 (72%) with bilateral hearing loss, including 7 patients receiving a second cochlear implant. All patients received MED-EL devices. Those with cochlear malformations or ossification were excluded.
The investigators assessed procedural feasibility through robotic setup and alignment times, electrode insertion duration, insertion depth, intraoperative technical challenges, and integration into standard surgical workflow; completeness of electrode insertion; and procedural complications. The robotic system used foot pedal–controlled motorized advancement at a standardized speed of 0.1 mm/second.
Robotic setup and alignment required a mean of 374 seconds, including 135 seconds for positioning the robotic arm and 239 seconds for electrode mounting and trajectory alignment. Mean electrode insertion duration was 444 seconds, with occasional pauses for trajectory adjustments. The mean operative time from skin incision to closure was 83 minutes, ranging from 70 to 95 minutes.
Full electrode insertion was achieved in 49 of 50 patients, with 1 patient having an extracochlear electrode contact at the round window level. Postoperative imaging analysis in 33 cases demonstrated a mean angular insertion depth of 575°, including 561° and 602° with the two arrays. No major complications, including facial nerve palsy or infections, or device-related complications were reported.
The investigators reported that robotic insertion could be incorporated into conventional cochlear implant surgery without altering established mastoidectomy and posterior tympanotomy techniques. The robotic system was introduced immediately prior to electrode insertion, allowing preceding surgical steps to remain unchanged. Although initial cases required longer alignment times, efficiency improved after about 5 to 10 cases.
Technical challenges included limited facial recess exposure, electrode buckling, and trajectory misalignment. These difficulties occasionally required manual adjustments or conversion to conventional forceps for insertion of the final electrode contact. The investigators observed that conversion to manual insertion became less frequent with experience, particularly as electrode mounting and trajectory alignment techniques improved.
The study was limited by its retrospective, single-center design, small sample, and absence of a manual insertion comparison group. Patients with complex cochlear anatomy were excluded, limiting generalizability. Hearing preservation and speech perception outcomes were unavailable because meaningful audiometric assessment required at least 12 months of follow-up. The investigators could not establish whether robotic insertion reducedintracochlear trauma or improved hearing outcomes compared with conventional techniques. They identified cost and accessibility as potential barriers to broader adoption.
The findings suggest that robot-assisted cochlear electrode insertion using the Otoarm-Otodrive system may be integrated into routine surgical practice with manageable setup times and favorable early procedural outcomes. “Ongoing follow-up will clarify its role in optimizing hearing preservation outcomes,” wrote lead study author Kevin Jer V. David, MD, of Sunnybrook Health Sciences Centre at the University of Toronto, and colleagues.
Full disclosures of the study authors can be found in the study.
