ARTORG image-guided robot for cochlear implantation

The world’s first ever robot-assisted cochlear implant surgery was performed with the Swiss ARTORG group's surgical robot  prototype - as reported in Science Robotics. 

 

"The robotic treatment model encompasses computer-assisted surgery planning, precision stereotactic image guidance, in situ assessment of tissue properties, and multipolar neuromonitoring, all based on in vitro, in vivo, and pilot data. The model is expandable to integrate additional robotic functionalities such as cochlear access and electrode insertion. Our results demonstrate the feasibility and possibilities of using robotic technology for microsurgery on the lateral skull base. It has the potential for benefit in other microsurgical domains for which there is no task-oriented robotic technology available at present."

"Cochlear Implantation is a microsurgical procedure that allows the placement of an electronic prosthesis into the cochlea to restore hearing in a deaf patient. The surgery involves the milling of an opening in the skull bone to reach the cochlea. The current, conventional procedure is carried out manually by the otologists and relies on visual identification of anatomical landmarks through the opening in the skull, to avoid damage to anatomical structures such as the facial nerve. Here a multidisciplinary team of biomedical engineers, neuroradiologists, neurologists, audiologists, allied health professionals and surgeons of the Hearing Research Laboratory and Image-Guided Therapy Groups at the ARTORG Center together with the Department of Otolaryngology, Inselspital, present their work on robotic cochlear implantation, in the March issue of Science Robotics, Weber et al.  Robotic cochlear implantation is based on the creation of a drill tunnel with a diameter of 1.8mm straight to the cochlea from behind the ear of the patient, without visual or haptic control by the surgeon.
“This publication is a demonstration of the team work that makes research at the ARTORG Center unique among most bioengineering research institutions worldwide. It is the culmination of an 8-year research effort that has resulted in the first RCI in a patient at the Inselspital, Bern University Hospital, performed by Vice Director ARTORG Artificial Hearing Research Prof. Dr. med. Marco Caversaccio in close collaboration with the groups here at the ARTORG. We are encouraged by our findings and excited to see where our research will take us next”, says Prof. Dr.-Ing. Stefan Weber, Director ARTORG Center for Biomedical Engineering Research, University of Bern, Switzerland."

"The development team comes from the University of Bern in Switzerland’s ARTORG Center for Biomedical Engineering Research. Lead study author Stefan Weber told Popular Science that it took them over eight years to perfect the robot.  That timeline might seem a bit long when one compares its development to other robots in the field. However, this robot has to work in a highly complex environment doing a very specific and pointed task. Cochlear implant surgeries help restore hearing in patients with partial function of their cochlear nerve. Conventional methods require surgeons to open up a patient’s skull and work within an area the size of a Euro coin. It’s only after this opening has been made that the hearing device’s electrode can be implanted.

  “Humans are operating at the limits of their skill-sets, haptically and visually,” Weber said. “But if it’s designed right, a robotic system can operate at any resolution—whether it’s a millimeter you need or a tenth of a millimeter.”  The robot allows for drilling an even more narrow tunnel into the inner ear’s temporal bone. The tunnel will snugly fit the electrode, and a smaller hole means less time a patient will have to recover from surgery. Most cochlear implant surgeries occur in small children, so reducing ‘down time’ will more than likely lead to happier patients.  The video below from 2013 shows displays some close-up footage of testing out and fine-tuning the custom-built robotics:  The robot assisted in its first surgery on a 51-year-old female patient last year. It’s been used three times since then, and all surgeries were considered successes. The patients are still being monitored to evaluate their overall hearing experience.  Weber said the process is far from being fully automated. However, he wants to continue to “optimize” the process. The team is working on developing a robot to finalize the implantation and thread the electrode into the inner ear."

Source: Science Robotics, Interesting Engineering, ARTORG, Science Daily, MedGadget