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Background: Robotic surgery in the last years has gained popularity in otology as an effective tool to improve the accuracy of surgical gestures by reducing involuntary movements of the surgeon such as tremor, drift, undershoot and overshoot, and jerk-a sudden muscular reflex. Moreover, it could improve the force-control feedback. Recent studies report that cochlear implantation may take advantage of the robotic assistance in all the steps of the surgery: the approach to the middle ear by automated mastoidectomy and posterior tympanotomy through a tunnel also known as direct cochlea access; a minimally invasive cochleostomy by means of robotassisted drilling tool; the alignment of the correct insertion axis on the cochlear basal turn; the insertion of the electrodes array via motorized insertion tools. Methods: We report the experience of the cochlear implantation with the RobOtol® system, a robot-based teleoperated arm with 6 df developed to be able to operate in the middle ear and mastoid. Cochlear insertions are possible using specific tools available for the different electrode arrays (straight or precurved) that can be connected to the instrument holder arm. After the opening of the round window membrane, the array is aligned to the chosen insertion axis and pushed in the scala tympani by the controlled movement of the robotic arm; for this purpose, all the axes of freedom of the robot are blocked (X-, Y-, and rotation axes) with the exception of the Z-axis, allowing the robot arm to move linearly along the trajectory at constant low insertion speed. In the present series, both straight (8 Cochlear CI522/622 and 8 AB Slim J) and precurved (4 AB Mid-Scala) electrode arrays were robotically implanted and matched to 40 manual implantations. Three-dimensional reconstruction images of the basilar membrane and the electrode arrays were obtained from pre- and postimplantation CT scans, and intracochlear EA position was analyzed. Results: At present, more than 100 CIs have been implanted with the aid of RobOtol® in several cochlear implant centers around Europe and China, and the number of procedures and published data from these groups is rapidly increasing. For straight electrode arrays, scalar translocations occurred in 19% of the robot-assisted group and 31% of the manually inserted group. Considering the number of translocated electrodes, this was lower in the robot-assisted group (7%) than in the manually inserted group (16%) (P < .0001). For precurved electrode arrays, scalar translocations occurred in 50% of the robot-assisted group and 38% of the manually inserted group. The average total time of surgery was 138±7.1 minutes versus 109±4.0 minutes for the manual insertions. Conclusion: The results from the first robotized electrode arrays insertions were very encouraging, showing a trend to less traumatic insertion compared with manual insertion. The use of robot-assisted insertion allows a slow and constant insertion speed and the possibility to modify the insertion axis during the insertion, for example, in the case of changes during intraoperative electrocochleography recording. Furthermore, preoperative calculation of the optimal insertion axis enables a robotic semiautomated insertion and would further reduce the incidence of electrode array misplacement. [ABSTRACT FROM AUTHOR]

Objective: To investigate the characteristics of morphological changes of inner retinal layer after internal limiting membrane peeling in macular hole surgery. Methods: Retrospective case study. Patients with idiopathic macular hole from 2015 to 2018 underwent vitrectomy+internal limiting membrane peeling (inverting)+ gas tamponade in China-Japan Friendship Hospital were investigated. A total of 19 eyes (17 patients) were enrolled, including 4 males (4 eyes) and 13 females (15 eyes). The average age was 62.74±5.25 years. Optical coherence tomography (OCT) was used to obtain the topographic maps of retinal thickness, the thickness of retinal ganglion cell complex and probability maps, and the Angio/en-face maps of macular retina. The characteristics of the morphological changes of the inner retinal were comprehensively analyzed. Results: Among 19 eyes, 9 eyes had internal limiting membrane peeling, 8 eyes had lotus-like internal limiting membrane inverting, and 2 eyes had the uper180 degrees internal limiting membrane inverting. The minimum diameter of macular hole was (543.06+220.17) μm and the maximum diameter was (947.18+319.12) μm. The follow-up time was (21.05+9.66) months, and the visual acuity was 0.45+0.35 at the last follow-up. In the 19 eyes, all the macular holes were closed postoperatively and dissociated optic nerve fiber layer appearance (DONFL) and concentric macular dark spots (CMDS) all showed, as well as mGCC thinning. The changes of CMDS and mGCC in 2 eyes in the uper180 degrees internal limiting membrane inverting group were mainly seen in the upper retina and in the remaining 17 eyes were seen diffused around the macula, which roughly corresponded to the extent of internal limiting membrane peeling. Two eyes showed clear decrease of retinal capillary density on Angio/map. Conclusions: Long-term morphological changes of the inner retinal after internal limiting membrane peeling in macular hole surgery are obvious. In addition to the appearance changes like DONFL and CMDS, the macular ganglion cell complex (mGCC) is also involved. (Chin J Ophthalmol, 2019, 55:747 - 756) .