Robotics-Assisted Cochlear Implant Insertion.

The degree of intracochlear trauma and force associated with manual electrode insertion may negatively impact cochlear implant (CI) outcomes and preservation of residual acoustic hearing. Robotics-assisted CI insertion systems have recently been developed to overcome human kinematic constraints associated with manual surgical techniques to allow lower force and slower electrode insertions, with the goal of improving performance and hearing preservation outcomes. The iotaSOFT (iotaMotion Inc., USA) is an FDA approved robotics-assisted CI insertion tool compatible with modern lateral-wall electrode designs. Pre-clinical studies suggest lower force and less traumatic CI insertions are possible with this system compared to manual insertion techniques. The slower insertion speeds of this system allow more precise control of electrode insertion in response to simultaneous electrocochleography feedback. We demonstrate application of this system with concurrent electrocochleography for hearing preservation cochlear implantation and highlight relevant surgical technique (see Video, Supplemental Digital Content 1, which demonstrates robotics-assisted CI insertion).