Objective:
To assess the feasibility, workflow integration, and procedural safety of robot-assisted cochlear electrode insertion using the Otoarm-Otodrive system.
Approach:
- Design and participants: Retrospective descriptive study of 50 consecutive adults who underwent cochlear implantation at one Canadian tertiary referral center from January to October 2025. Patients with cochlear malformations or ossification were excluded.
- Procedure and assessment: All patients received MED-EL devices. Investigators assessed robotic setup and alignment, insertion time and depth, technical challenges, workflow integration, insertion completeness, and complications. The system advanced electrodes at 0.1 mm/second.
Key Findings:
- Mean robotic setup and alignment time was 374 seconds; mean electrode insertion time was 444 seconds.
- Mean operative time from incision to closure was 83 minutes (range, 70–95 minutes).
- Full electrode insertion was achieved in 49 of 50 patients; one patient had an extracochlear contact at the round window level.
- Imaging in 33 cases showed a mean angular insertion depth of 575°.
- No major complications, including facial nerve palsy or infection, or device-related complications were reported.
- The robotic system was introduced before electrode insertion, leaving preceding surgical steps unchanged. Alignment efficiency improved after approximately 5 to 10 cases.
Interpretation:
The investigators reported that robotic insertion could be incorporated into conventional cochlear implant surgery, with technical challenges sometimes requiring manual adjustment or conversion to forceps.
Limitations:
- Retrospective, single-center design and small sample.
- No manual-insertion comparison group; patients with complex cochlear anatomy were excluded.
- Hearing preservation and speech perception outcomes were unavailable because follow-up was insufficient for meaningful audiometric assessment.
- The study could not determine whether robotic insertion reduced intracochlear trauma or improved hearing outcomes. Cost and accessibility were identified as potential barriers.
Conclusion:
The authors described favorable early procedural outcomes and stated that ongoing follow-up will clarify the system’s role in optimizing hearing preservation outcomes.
Sources:
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