Clinical Scorecard: Robot-assisted cochlear electrode insertion: procedural feasibility in 50 adults

At a Glance

Key Highlights

• Retrospective descriptive study of 50 consecutive adult patients treated with the Otoarm-Otodrive system between January and October 2025.
• Full electrode insertion was achieved in 49 of 50 patients; one patient had an extracochlear contact at the round window level.
• Mean robotic setup and alignment time was 374 seconds, and mean electrode insertion duration was 444 seconds.
• No major complications, including facial nerve palsy or infection, or device-related complications were reported.
• The investigators could not establish whether robotic insertion reduced intracochlear trauma or improved hearing outcomes compared with conventional techniques.

Guideline-Based Recommendations

Diagnosis

Management

• The robotic system was introduced immediately prior to electrode insertion; preceding mastoidectomy and posterior tympanotomy steps were unchanged.
• Technical challenges sometimes required manual adjustments or conversion to conventional forceps for insertion of the final electrode contact.

Monitoring & Follow-up

• Postoperative imaging in 33 cases showed a mean angular insertion depth of 575°.
• Hearing preservation and speech perception outcomes were unavailable because meaningful audiometric assessment required at least 12 months of follow-up.

Risks

• Reported technical challenges included limited facial recess exposure, electrode buckling, and trajectory misalignment.
• The study was limited by its retrospective, single-center design, small sample, lack of a manual-insertion comparison group, and exclusion of patients with complex cochlear anatomy.
• The investigators identified cost and accessibility as potential barriers to broader adoption.

Patient & Prescribing Data

Full insertion was achieved in 49 patients. Mean operative time from skin incision to closure was 83 minutes (range, 70–95 minutes). The investigators reported that alignment efficiency improved after approximately 5 to 10 cases and conversion to manual insertion became less frequent with experience.

Clinical Best Practices

• The investigators reported that robotic insertion could be incorporated into conventional cochlear implant surgery without changing established mastoidectomy and posterior tympanotomy techniques.
• The system used foot pedal–controlled motorized advancement at 0.1 mm/second.
• The investigators stated that ongoing follow-up is needed to clarify the system’s role in hearing preservation outcomes.

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