Image-Based Planning of Minimally Traumatic Inner Ear Access for Robotic Cochlear Implantation

Objective: During robotic cochlear implantation, an image-guided robotic system provides keyhole access to the scala tympani of the cochlea to allow insertion of the cochlear implant array. To standardize minimally traumatic robotic access to the cochlea, additional hard and soft constraints for inn...

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Autores principales:	Fabian Mueller, Jan Hermann, Stefan Weber, Gabriela O'Toole Bom Braga, Vedat Topsakal
Formato:	article
Lenguaje:	EN
Publicado:	Frontiers Media S.A. 2021
Materias:	sensorineural hearing loss task-autonomous robotics computer-assisted surgery image-guided surgery cochlear implantation patient-specific planning Surgery RD1-811
Acceso en línea:	https://doaj.org/article/c079dc07ea254f05ab77bf92a18a7ee9
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spelling	oai:doaj.org-article:c079dc07ea254f05ab77bf92a18a7ee92021-11-30T21:49:03ZImage-Based Planning of Minimally Traumatic Inner Ear Access for Robotic Cochlear Implantation2296-875X10.3389/fsurg.2021.761217https://doaj.org/article/c079dc07ea254f05ab77bf92a18a7ee92021-11-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fsurg.2021.761217/fullhttps://doaj.org/toc/2296-875XObjective: During robotic cochlear implantation, an image-guided robotic system provides keyhole access to the scala tympani of the cochlea to allow insertion of the cochlear implant array. To standardize minimally traumatic robotic access to the cochlea, additional hard and soft constraints for inner ear access were proposed during trajectory planning. This extension of the planning strategy aims to provide a trajectory that preserves the anatomical and functional integrity of critical intra-cochlear structures during robotic execution and allows implantation with minimal insertion angles and risk of scala deviation.Methods: The OpenEar dataset consists of a library with eight three-dimensional models of the human temporal bone based on computed tomography and micro-slicing. Soft constraints for inner ear access planning were introduced that aim to minimize the angle of cochlear approach, minimize the risk of scala deviation and maximize the distance to critical intra-cochlear structures such as the osseous spiral lamina. For all cases, a solution space of Pareto-optimal trajectories to the round window was generated. The trajectories satisfy the hard constraints, specifically the anatomical safety margins, and optimize the aforementioned soft constraints. With user-defined priorities, a trajectory was parameterized and analyzed in a virtual surgical procedure.Results: In seven out of eight cases, a solution space was found with the trajectories safely passing through the facial recess. The solution space was Pareto-optimal with respect to the soft constraints of the inner ear access. In one case, the facial recess was too narrow to plan a trajectory that would pass the nerves at a sufficient distance with the intended drill diameter. With the soft constraints introduced, the optimal target region was determined to be in the antero-inferior region of the round window membrane.Conclusion: A trend could be identified that a position between the antero-inferior border and the center of the round window membrane appears to be a favorable target position for cochlear tunnel-based access through the facial recess. The planning concept presented and the results obtained therewith have implications for planning strategies for robotic surgical procedures to the inner ear that aim for minimally traumatic cochlear access and electrode array implantation.Fabian MuellerJan HermannStefan WeberGabriela O'Toole Bom BragaVedat TopsakalVedat TopsakalFrontiers Media S.A.articlesensorineural hearing losstask-autonomous roboticscomputer-assisted surgeryimage-guided surgerycochlear implantationpatient-specific planningSurgeryRD1-811ENFrontiers in Surgery, Vol 8 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	sensorineural hearing loss task-autonomous robotics computer-assisted surgery image-guided surgery cochlear implantation patient-specific planning Surgery RD1-811
spellingShingle	sensorineural hearing loss task-autonomous robotics computer-assisted surgery image-guided surgery cochlear implantation patient-specific planning Surgery RD1-811 Fabian Mueller Jan Hermann Stefan Weber Gabriela O'Toole Bom Braga Vedat Topsakal Vedat Topsakal Image-Based Planning of Minimally Traumatic Inner Ear Access for Robotic Cochlear Implantation
description	Objective: During robotic cochlear implantation, an image-guided robotic system provides keyhole access to the scala tympani of the cochlea to allow insertion of the cochlear implant array. To standardize minimally traumatic robotic access to the cochlea, additional hard and soft constraints for inner ear access were proposed during trajectory planning. This extension of the planning strategy aims to provide a trajectory that preserves the anatomical and functional integrity of critical intra-cochlear structures during robotic execution and allows implantation with minimal insertion angles and risk of scala deviation.Methods: The OpenEar dataset consists of a library with eight three-dimensional models of the human temporal bone based on computed tomography and micro-slicing. Soft constraints for inner ear access planning were introduced that aim to minimize the angle of cochlear approach, minimize the risk of scala deviation and maximize the distance to critical intra-cochlear structures such as the osseous spiral lamina. For all cases, a solution space of Pareto-optimal trajectories to the round window was generated. The trajectories satisfy the hard constraints, specifically the anatomical safety margins, and optimize the aforementioned soft constraints. With user-defined priorities, a trajectory was parameterized and analyzed in a virtual surgical procedure.Results: In seven out of eight cases, a solution space was found with the trajectories safely passing through the facial recess. The solution space was Pareto-optimal with respect to the soft constraints of the inner ear access. In one case, the facial recess was too narrow to plan a trajectory that would pass the nerves at a sufficient distance with the intended drill diameter. With the soft constraints introduced, the optimal target region was determined to be in the antero-inferior region of the round window membrane.Conclusion: A trend could be identified that a position between the antero-inferior border and the center of the round window membrane appears to be a favorable target position for cochlear tunnel-based access through the facial recess. The planning concept presented and the results obtained therewith have implications for planning strategies for robotic surgical procedures to the inner ear that aim for minimally traumatic cochlear access and electrode array implantation.
format	article
author	Fabian Mueller Jan Hermann Stefan Weber Gabriela O'Toole Bom Braga Vedat Topsakal Vedat Topsakal
author_facet	Fabian Mueller Jan Hermann Stefan Weber Gabriela O'Toole Bom Braga Vedat Topsakal Vedat Topsakal
author_sort	Fabian Mueller
title	Image-Based Planning of Minimally Traumatic Inner Ear Access for Robotic Cochlear Implantation
title_short	Image-Based Planning of Minimally Traumatic Inner Ear Access for Robotic Cochlear Implantation
title_full	Image-Based Planning of Minimally Traumatic Inner Ear Access for Robotic Cochlear Implantation
title_fullStr	Image-Based Planning of Minimally Traumatic Inner Ear Access for Robotic Cochlear Implantation
title_full_unstemmed	Image-Based Planning of Minimally Traumatic Inner Ear Access for Robotic Cochlear Implantation
title_sort	image-based planning of minimally traumatic inner ear access for robotic cochlear implantation
publisher	Frontiers Media S.A.
publishDate	2021
url	https://doaj.org/article/c079dc07ea254f05ab77bf92a18a7ee9
work_keys_str_mv	AT fabianmueller imagebasedplanningofminimallytraumaticinnerearaccessforroboticcochlearimplantation AT janhermann imagebasedplanningofminimallytraumaticinnerearaccessforroboticcochlearimplantation AT stefanweber imagebasedplanningofminimallytraumaticinnerearaccessforroboticcochlearimplantation AT gabrielaotoolebombraga imagebasedplanningofminimallytraumaticinnerearaccessforroboticcochlearimplantation AT vedattopsakal imagebasedplanningofminimallytraumaticinnerearaccessforroboticcochlearimplantation AT vedattopsakal imagebasedplanningofminimallytraumaticinnerearaccessforroboticcochlearimplantation
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Image-Based Planning of Minimally Traumatic Inner Ear Access for Robotic Cochlear Implantation

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