Did you have any reservations about the process and how it works?
Gstöttner: My biggest concern was that the inserted cochlea electrode could somehow become entangled or that we would be unable to maintain control over the process. After all, you must navigate the electrode through the channel and the cochlea – that’s an insertion depth of about six centimeters (2,4 inches).
During the first surgery, we therefore used a tiny microscope to monitor through the eardrum whether the electrode is guided properly and is in the correct position. I haven’t done this in recent times because the drilled channel is so precise and consistent, which makes the electrode insertion a very safe process. I am fully satisfied and completely confident about it.
How many surgeries have been performed at your hospital with HEARO?
Gstöttner: Unfortunately, we have only performed three implantations to date. The preselection of patients is a very intricate and elaborate process. Not all persons who might be suited can be candidates because you must ensure a particular angle to approach from the surface of the skull to the inner ear to allow the drill to bypass the facial nerve by at least 50 micrometers. We cannot use the robot if this is not the case.
Patient education is also quite difficult as not all patients are excited about the idea of being the first person that undergoes surgery with the equipment.
Hence for now, the overall surgery time is much longer than the conventional cochlear implantation. We are still in a learning phase. Right now, the precise preparation before the surgery pertaining to the navigation is the most complex part. The robot’s mere drilling task doesn’t take long at all, but the navigation must be adjusted with screws, and you must also perform another CT scan.
That being said, we have planned more surgeries.
What will the future of the surgical robot look like?
Gstöttner: We can perform the conventional surgical procedure very well. However, from a global perspective, I am sure that robots will soon handle these conventional interventions exclusively.
Our goal is to use the robot for procedures that we can no longer perform with the same accuracy and precision. After all, cochlear implantations go along with a variety of complicated situations. These may include facial nerve abnormalities or anatomic variations, ossification, or other issues.
We are presently looking for solutions to problems that only a robot can solve. And this is an area where we expect to see exciting changes in our field this year.