HEARO Robotic Cochlear Implantation

 HEARO is a cochlear implant surgical robot,  developed by CAScination AG, together with MED-EL.

"Research in the Surgical Robotics group at the ARTORG Center has led to the development of a dedicated, image-guided, safety-assured, task autonomous surgical robot for cochlear implantation.  The robotic cochlear implantation project has been translated into the hands of surgeons and in a clinical trial 5 patients have been implanted so far using robotic technology.  CAScination and MED-EL GmbH have accessed the technology commercially and a cochlear implant robot product - HEARO®, is undergoing regulatory approval.  Plans for the HEARO® technology going forward include paediatric applications and other uses in ENT surgery."

"With the clinical implementation of the HEARO® procedure, a robotically assisted and image-guided approach, a new era for cochlear implant surgery has begun. The improvements of hearing restoration with an implant start with an individualised approach from its early beginning and before the surgery: the 3D visualisation of the anatomy, the assessment of the cochlea size, the individualised electrode selection and the preoperative planning of the surgical access. The surgical planning enables us to tailor-fit the solution for every patient before the incision. The plan is then executed by the robot with an unmatched accuracy and precision in the range of microns, not millimeters. The high precision of action allows to predict the contact locations of the electrode within the cochlear and to estimate the stimulation frequencies for an optimal fitting."

"In 2016, Prof. Caversaccio of Insel Hospital, Bern, proved that it was possible to safely pass the facial recess and perform a robotic access to the middle ear cavity using this technology. Then in 2018 December 10th, Professor Topsakal performed the first HEARO robotic cochlear implantation procedure on a patient at UZA Antwerp University Hospital.

HEARO creates straight trajectory from the mastoid surface to the scala tympani at the ideal approach angle for entering the cochlea through the round window, allowing the surgeon to gently insert the flexible electrode array directly into the scala tympani.

The HEARO procedure replaces the traditional mastoidectomy, posterior tympanotomy, and removal of the bony overhang with a precisely drilled channel directly to the round window of the cochlea. The entire procedure is planned by the surgeon pre-operatively using OTOPLAN® software.

HEARO uses multiple integrated safety measures to minimize the risk of structural or heat damage to the facial nerve, chorda tympani, and other critical anatomical structures. Active safety measures include continuous neuromonitoring, interoperative imaging-based verification of safety margins with OTOPLAN, and real-time responsive torque-force monitoring while drilling. Additional passive safety elements include micro-precision image guidance and specialized robotic drilling technology developed to minimize any heat generation.

When approaching and passing through the facial recess, HEARO provides advanced facial nerve monitoring to actively map the safety margins to the facial nerve, fully independent of image guidance."

Source: Medel, ARTORG, ENT and Audiology News