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BackTable / ENT / Article
Robot-Assisted Cochlear Implant Surgery
Julia Casazza • Mar 5, 2024 • 38 hits
iotaMotion’s iotaSOFT robot assists surgeons during the critical portion of cochlear implant (CI) surgery (i.e. the insertion of the electrode into the cochlea). Here, Dr. Marlan Hansen and Dr. Chris Kaufmann, founders of iotaMotion, discuss the adoption of and future applications of their technology. Interested in learning more? Continue reading to learn about how robotics could change your surgical practice.
This article features excerpts from the BackTable ENT Podcast. We’ve provided the highlight reel in this article, but you can listen to the full podcast below.
The BackTable ENT Brief
• The iotaMotion iotaSOFT robot can insert lateral wall electrodes from all cochlear implant manufacturers. The use of the robot requires normal cochlear anatomy. Patients with cochlear malformations, ossification, or extensive scarring cannot undergo robot-assisted surgery.
• Robot-assisted cochlear implant insertion provides greater control over electrode placement while enabling the use of technologies (such as electrocochleography (ECoG)) that provide real-time feedback during surgery.
• Future applications of the iotaSOFT robot include integration with ECoG, imaging, and pre-surgical planning technology.
• Dr. Hansen and Dr. Kaufmann advise aspiring surgeon-entrepreneurs to remain resilient, build a good team, and work with their university’s technology transfer personnel when bringing their ideas to fruition.
Table of Contents
(1) Using the iotaSOFT Robot to Insert Cochlear Implants
(2) Encouraging Surgeon Uptake of iotaMotion’s iotaSOFT Robot
(3) The Future of Robot-Assisted Cochlear Implant Surgery
Using the iotaSOFT Robot to Insert Cochlear Implants
Compared to a human hand, the iotaMotion robot can insert an implant more steadily, thus minimizing surgical trauma. While surgeons can feel when the electrode goes into the cochlea, the robot measures forces on the electrode array and adjusts insertion accordingly. Currently, iotaMotion’s iotaSOFT robot is compatible with lateral wall electrodes from all manufacturers; technology to insert perimodiolar electrodes is under development. Patients must have normal cochlear anatomy – meaning no malformations, ossification, or extensive scarring – to benefit from robot-assisted insertion.
[Dr. Eric Gantwerker]
When surgeons are doing the insertion, they can feel that a little bit of feedback when it feels like it's gone in. How does the robot know when to stop and does it have that force feedback on the electrode array?
[Dr. Chris Kaufmann]
I actually started in the lab looking at different insertion forces and that's how the whole system develops. Really what we found is it's the slow insertion speed that actually overshoots and decrease in the outliers that actually decreases the overall forces and causes the high spikes that cause the damage in the lab, at least. In an effort to kind of fit it in, the cost perspective plus intraoperative setting and keep it small and miniature and disposable, what we found was that you can actually with the buckling electrode array, we have, we can visualize the forces.
Marlan can talk more to this. Visualize the actual forces just by the inherent mechanical properties as well as there's some built-in hardware-based maximums if you will, that limit that.
[Dr. Marlan Hansen]
Yes, maybe a point to bring out is actually a surgeon can't sense the type of forces that would cause trauma within the cochlear. If a surgeon is feeling some major resistance either there's a lot of scarred tissue or other things built up in that ear or your charging through some things and the damage has been done. It's well below the threshold of what a human can perceive, a human hand.
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Encouraging Surgeon Uptake of iotaMotion’s iotaSOFT Robot
Like many other professionals, surgeons share concerns that technological advancements will change their job prospects. When describing their device, the founders of iotaMotion characterize the robot as a tool to augment a surgeon’s existing skill set. The robot performs a smoother, steadier insertion that increases surgeon control over the whole procedure. The use of iotaMotion in the OR allows engagement with other technologies that provide real-time surgical feedback. Electrocochleography (ECoG), which measures electrical stimulus to the cochlea, is one such example.
[Dr. Marlan Hansen]
I've used it many times and one of the great things is it enables other technologies that complement what we're doing. We now use technologies, for instance, the electrocochleography, which is a way of monitoring the function of the cochlea. You can now integrate your insertion with these other devices and you have much more control, much better ability to respond and to deal with whatever's happening if you do these things robotically. You just feel a lot more comfortable with what you're doing, you know what's going on.
You can think of this as like driving a car, I think, is a good analogy. You just go really slow and you're not going to cause problems. Even if you do happen to hit a tree, you're not going to dent your fender if you're going slow. It does though, enable a lot of these other technologies. The other thing that was really fun, is we had a couple of patients where they have hearing in their ear that we're not putting the electrode in and we do it under local. We can be stimulating the implant that we're putting in while we're putting in and robotically going very slow.
They can tell us how it matches the tones that we're putting in their other ear. We put a 750-hertz tone in their other ear and they say, "It's a little bit higher than that." Put another tone in, "Now it's getting lower. Now it's close. That's it. That matches that tone I'm hearing in my other ear." We can do all of that while the patient's awake and we're putting in the electrode. Some of those things, you just can't do that if you're doing it manually. It makes it fun for the surgeon.
The Future of Robot-Assisted Cochlear Implant Surgery
The founders of iotaMotion envision improving the care of CI patients through increased applications of their insertion system. They plan to integrate the insertion system with technologies including electrocochleography (ECoG), imaging, and pre-surgical planning technology. Ultimately, they want to integrate their insertion system with the electrode itself. This integration would enable clinic-based adjustment of electrode location to treat subsequent hearing loss. Reflecting on their work so far, Dr. Hansen and Dr. Kaufmann encourage aspiring surgeon-entrepreneurs to pursue projects that combine technical expertise with drive.
[Dr. Marlan Hansen]
We're very much in a limited market release, where we're just doing our initial few 100 cases, and really have a good sense of how it's performing out in the field and what we need to do. We already know of some things that we're doing to improve the next version that comes out. Then we have several other complementary and additional technologies that build on top of this. This is the first thing, and it's going to go from something that does just lateral wall electrode arrays to do all electrode arrays.
It's going to move from something where we now integrate it with other technologies, whether it's electrocochleography, or imaging, or preoperative planning. Like Chris talked about earlier, eventually, the vision is that this becomes implanted with the original cochlear implant. Then we can access that transcutaneous or percutaneously while the patient's awake in the clinic. We can adjust or dial in the position of the electrode array for that individual patient, so that we can either move it forward if they lose further hearing.
Two years later, we can move it forward, or if they have a dead zone in their cochlea that's not been able to be stimulated, we can adjust the position of the electrodes. It personalizes the position of the electrode for individual patients. We're obviously interested in, not just cochlear implants, but there's a lot of other medical devices that require a similar type precision that are based on the same concepts.
…
[Dr. Marlan Hansen]
If you have something and you think it's going to work, you ought to give it a try. Go for it. Sometimes it may take you a while. It's probably going to go a little bit differently than you initially conceived and you've got to be willing to bring people on and work with people and listen and understand, really, but it's fun. It's a fun journey and I think the fun part of it is to see something that you think can be a benefit and then see it through to where it actually is making an impact in patients' lives. It becomes very meaningful and gratifying at that point. Do it.
[Dr. Eric Gantwerker]
Chris, any thoughts?
[Dr. Chris Kaufmann]
For me, it was always fun. I think that's the key thing that starts with that. Do something that doesn't feel like work, but you're spending every minute of the day doing. Combine that with a passion and drive. I think the scene that we've said throughout this is really persistence because there's going to be roadblocks and you just have to be able to iterate ways around it. If you have that discipline and just keep the purpose and target in mind and the goal in mind, you'll get there.
Podcast Contributors
Dr. Marlan Hansen
Dr. Marlan Hanen is a clinician-scientist trained in neurotology/skull base surgery and cell and molecular biology. He is a Department Chair of Otolaryngology and a Professor of Neurosurgery and Molecular Physiology & Biophysics at the University of Iowa.
Dr. Christopher Kaufmann
Dr. Christopher Kaufmann was an Otolaryngology Head & Neck Surgery resident and NIH research fellow at the University of Iowa prior to leaving surgical training to join iotaMotion full time to lead product portfolio strategy and technology development.
Dr. Eric Gantwerker
Eric Gantwerker is a Pediatric Otolaryngologist at Cohen Children's Hospital at Northwell Health/Hofstra, Associate Professor of Otolaryngology at Zucker School of Medicine at Hofstra/Northwell, and Vice President, Medical Director at Level Ex.
Cite This Podcast
BackTable, LLC (Producer). (2023, January 10). Ep. 84 – Your Implant Robot: The Future of Robotic Assisted Surgery [Audio podcast]. Retrieved from https://www.backtable.com
Disclaimer: The Materials available on BackTable.com are for informational and educational purposes only and are not a substitute for the professional judgment of a healthcare professional in diagnosing and treating patients. The opinions expressed by participants of the BackTable Podcast belong solely to the participants, and do not necessarily reflect the views of BackTable.
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