1. Anatomical investigation of safety determining factors for keyhole drilling trajectories for robotic cochlear implant surgery.
- Author
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Adanır SS, Kervancıoğlu P, Bahşi İ, Al Saadi M, Van de Heyning P, and Topsakal V
- Abstract
Purpose: Cochlear implants (CI) are the most successful bioprosthesis in medicine probably due to the tonotopic anatomy of the auditory pathway and of course the brain plasticity. Correct placement of the CI arrays, respecting the inner ear anatomy are therefore important. The ideal trajectory to insert a cochlear implant array is defined by an entrance through the round window membrane and continues as long as possible parallel to the basal turn of the cochlea. Image-guided surgery can directly drill with a robotic arm through the mastoid and execute an exact drilling of this precalculated most ideal trajectory. Here, we aim to identify critical anatomical structures determining the safest keyhole drilling trajectory by comparing easy and difficult CI surgeries performed with the HEARO Procedure: a robotic tool for image-guided surgery., Methods: Cone-beam computed tomography images of patients who underwent robot-assisted cochlear implantation surgery (RACIS) were included. Three of 25 cases had to be converted to conventional surgery because of the current safety mitigations based on anatomical distance. Radiological images in DICOM format were transferred to dedicated software (OTOPLAN® Cascination GMHB Bern Switzerland) for analyses. Surgical segmentation and previously planned trajectories were analyzed for these 25 cases by comparing cochlear sizes, facial recess sizes, round window sizes, and trajectory angles. In addition, facial recess angle, and cochlear orientation angles were measured with RadiAnt DICOM Viewer (Medixant, Pozan, Poland)., Results: Facial recess size, facial recess angle, and distance between the facial nerve and safe trajectory were smaller in patient who converted from robotic surgery to conventional. A significant positive correlation existed between basal turn angle and in-plane angle (p = 0.001, r = 0.859). In addition, there was a significant negative correlation between the basal turn length and the last electrode insertion depth degree (p = 0.007, r = 0.545)., Conclusion: In our robotic surgery cases, we demonstrate that the limiting factors of anatomical relationships are constituted by the dimensions of the facial recess and the cochlear orientation. The findings of this study are considered to be a reference for future studies in achieving collision-free trajectory planning in robotic-assisted cochlear implant surgery., Competing Interests: Declarations. Ethical approval: Ethical approval was obtained from Medical Ethics Committee UZ Brussel Hospital with number 1432022000187. This study was presented as orally on the 7th World Congress of Cochlear Implantation in Emerging Nations in Istanbul, Turkey between 14 and 16 September 2023. This study was produced from the PhD thesis of Saliha Seda ADANIR (National Thesis Center ( https://tez.yok.gov.tr/ ), thesis id: 842389). Conflict of interest: The authors declare that they have no conflicts of interest., (© 2025. The Author(s).)
- Published
- 2025
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