A smart micro-drill for cochleostomy formation: a comparison of cochlear disturbances with manual drilling and a human trial

Article


Coulson, C. J., Zoka Assadi, M., Taylor, R. P., Du, X., Brett, P. N., Reid, A. P. and Proops, D. W.. 2013. "A smart micro-drill for cochleostomy formation: a comparison of cochlear disturbances with manual drilling and a human trial." Cochlear Implants International. 14 (2), pp. 98-106. https://doi.org/10.1179/1754762811Y.0000000018
Article Title

A smart micro-drill for cochleostomy formation: a comparison of cochlear disturbances with manual drilling and a human trial

ERA Journal ID15955
Article CategoryArticle
AuthorsCoulson, C. J. (Author), Zoka Assadi, M. (Author), Taylor, R. P. (Author), Du, X. (Author), Brett, P. N. (Author), Reid, A. P. (Author) and Proops, D. W. (Author)
Journal TitleCochlear Implants International
Journal Citation14 (2), pp. 98-106
Number of Pages9
Year2013
Place of PublicationUnited Kingdom
ISSN1467-0100
1556-9152
Digital Object Identifier (DOI)https://doi.org/10.1179/1754762811Y.0000000018
Web Address (URL)http://www.tandfonline.com/doi/full/10.1179/1754762811Y.0000000018
Abstract

Background: Cochleostomy formation is a key stage of the cochlear implantation procedure. Minimizing the trauma sustained by the cochlea during this step is thought to be a critical feature in hearing preservation cochlear implantation. The aim of this paper is firstly, to assess the cochlea disturbances during manual and robotic cochleostomy formation. Secondly, to determine whether the use of a smart micro-drill is feasible during human cochlear implantation. Materials and methods: The disturbances within the cochlea during cochleostomy formation were analysed in a porcine specimen by creating a third window cochleostomy, preserving the underlying endosteal membrane, on the anterior aspect of the basal turn of the cochlea. A laser vibrometer was aimed at this third window, to assess its movement while a traditional cochleostomy was performed. Six cochleostomies were performed in total, three manually and three with a smart micro-drill. The mean and peak membrane movement was calculated for both manual and smart micro-drill arms, to represent the disturbances sustained within cochlea during cochleostomy formation. The smart micro-drill was further used to perform live human robotic cochleostomies on three adult patients who met the National Institute of Health and Clinical Excellence criteria for undergoing cochlear implantation. Results: In the porcine trial, the smart micro-drill preserved the endosteal membrane in all three cases. The velocity of movement of the endosteal membrane during manual cochleostomy is approximately 20 times higher on average and 100 times greater in peak velocity, than for robotic cochleostomy. The robot was safely utilized in theatre in all three cases and successfully created a bony cochleostomy while preserving the underlying endosteal membrane. Conclusions: Our experiments have revealed that controlling the force of drilling during cochleostomy formation and opening the endosteal membrane with a pick will minimize the trauma sustained by the cochlea by a factor of 20. Additionally, the smart micro-drill can safely perform a bony cochleostomy in humans under operative conditions and preserve the integrity of the underlying endosteal membrane.

Keywordscochlear implant; cochleostomy; laser vibrometer; robot surgery
ANZSRC Field of Research 2020400308. Medical devices
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Byline AffiliationsQueen Elizabeth Hospital, United Kingdom
Brunel University, United Kingdom
Aston University, United Kingdom
Institution of OriginUniversity of Southern Queensland
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