Bone drilling; Cochlea; Sensors; Image guided surgery; Electrode insertion; Robotics; Medical imaging processing
Müller Fabian, Schneider Daniel, Hermann Jan, Anso Juan, Pereira Bom Braga Gabriela, Matulic Marco, Weber Stefan (2019), Refined process model for robotic middle and inner ear access, in Burgert Oliver (ed.), Hochschule Reutlingen, Fakultät Informatik, Reutlingen.
Schneider Daniel, Stenin Igor, Ansó Juan, Hermann Jan, Mueller Fabian, Pereira Bom Braga Gabriela, Rathgeb Christoph, Wimmer Wilhelm, Schipper Joerg, Kristin Julia, Caversaccio Marco, Anschuetz Lukas, Weber Stefan, Klenzner Thomas (2019), Robotic cochlear implantation: feasibility of a multiport approach in an ex vivo model, in European Archives of Oto-Rhino-Laryngology
, 276(5), 1283-1289.
Schneider Daniel, Stenin Igor, Anso Juan, Hermann Jan, Müller Fabian Matthias, Braga Gabriela Pereira Bom, Weber Stefan, Anschütz Lukas Peter, Klenzner Thomas (2018), Feasibility of Robotic Multiport Cochlear Implantation - Evaluation in an Ex-Vivo Model, in CURAC
, Leipzig, Germany-, -.
Schneider Daniel, Anso Juan, Huth Markus, Stenin Igor, Anschütz Lukas Peter, Hermann Jan, Wimmer Wilhelm, Caversaccio Marco, Weber Stefan, Schipper Jörg, Klenzner Thomas (2017), Genauigkeit und Machbarkeit robotische Multi-Port Cochleaimplantation - Evaluierung am Phantom, in 25. Jahrestagung der Gesellschaft für Schädelbasischirurgie 2017
, Heidelberg, Germany-, -.
The Cochlear implant (CI) is a neuroprosthetic that restores hearing in patients with se-vere-to-profound sensorineural hearing loss (Eshraghi et al. 2012) , high frequency hear-ing loss (Turner et al. 2008) and unilateral hearing loss (Boyd 2015). During the microsur-gical CI implantation procedure, the otologist creates a cone-shaped access to the inner ear by passing through the mastoid bone, traversing past the facial nerve, the chorda tympani and ossicles. The otologist uses visual examination through the 20 mm opening to advance the drill either to the natural opening of the cochlea (round window) or an inci-sion into the cochlea (cochleostomy). Then the implant electrode is inserted into the coch-lea with as much care as the tactile abilities of the otologist permit. Once the implant is functional, the electrode sends out electric impulses to stimulate the spiral ganglion cells that innervate the fibres of the auditory nerve to convert external sounds into electronic signatures that are interpreted as hearing by the brain’s auditory cortex. CI implantation to date is a manual procedure in which variations in operator experience and skill are associated with inconsistent surgical and audiological outcomes. In particular trauma caused by the cochlear access, electrode insertion and electrode placement impact the effectiveness of hearing restoration (Lehnhardt 1993) (Roland 2005) (Pau et al. 2007). Limits of human tactile sensing, feedback and dexterity have proved a barrier to reduce procedural invasiveness and attempts to improve outcomes without computer assistance have been challenging (Coulson et al. 2007)(James et al. 2005). The investigation of aug-menting tools for CI surgery has resulted in the concept of Robotic Cochlea Implantation (RCI), in which each stage of the manual procedure is superseded by sensor data-driven devices. They will replace:i)the surgeon’s “decide as you go” approach with patient-specific computer based planning (CAP, phase 1) of all relevant treatment aspects using preoperatively ac-quired 3D imaging, ii)the manual middle and inner ear access with a minimally invasive robotic approach access to the middle ear (RMA, phase 2) and inner ear (RIA, phase 3) subsequently; iii)free-hand manual electrode insertion with speed & force controlled robotic electrode insertion (REI, phase 4). We have evolved the RCI model and demonstrated its feasibility for robotic middle ear ac-cess in patients (Weber et al. 2017). The work proposed herein focusses on the investigation of methods and approaches to complement our existing RCI model with clinically viable solutions for robotic inner ear access and robotic electrode insertion. The aim of this project is the investigation of an approach to inner ear access, including: aspects of geometric planning, multi sensor-based robotic control of the actual drilling process and investigation of tool-tissue interac-tion, all based on the development of suitable anatomical phantoms; as well as experi-mental investigation of efficiency and efficacy of the approach both in phantoms and in-vivo. Proposed research towards robotic electrode insertion encompasses the experimental investigation of different electrode insertion approaches through the combination of ele-ments such as previously developed insertion guide tubes, manual insertion, motorized insertion, and the monitoring and feedback of applicable insertion forces. Additionally, the feasibility of a multi-port approach (i.e. several drill trajectories for multiple instrument placement) to support a controlled and reproducible insertion process will be investigated. An experimental technical model incorporating reproducible conditions, anatomical varia-bility and sufficient complexity will be developed as part of the work.The experimental work conducted for each of the treatment modules will aid in determin-ing optimised technical and performance parameters that will underlie prototype compo-nents to be tested in in vitro and ex vivo pilot studies. Experimental results will also be used to investigate: i) the feasibility and benefits of performing all of the RCI modules in a robotic treatment model approach, and ii) the generalisability of a robotic treatment model for the development of novel skull-base applications for robotic surgery.