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Sriram S, Creighton FX, Galaiya D. Autonomous Robotic Systems in Otolaryngology-Head and Neck Surgery. Otolaryngol Clin North Am 2024; 57:767-779. [PMID: 38971627 DOI: 10.1016/j.otc.2024.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/08/2024]
Abstract
Robotic surgery is a growing field with increasing applications to patient care. With the rising use of artificial intelligence (AI), a new frontier emerges, allowing semiautonomous robotics. This article reviews the origins of robotic surgery and subsequent trials of automaticity in all fields. It then describes specific nascent robotic and semiautonomous surgical prototypes within the field of otolaryngology. Finally, broader systemic considerations are posited regarding the implementation of AI-driven robotics in surgery.
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Affiliation(s)
- Shreya Sriram
- Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Francis X Creighton
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Deepa Galaiya
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Hospital, Baltimore, MD, USA.
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Gottfried TM, Galeazzi P, Föger A, Dejaco D, Tröger A, Fischer N, Innerhofer V, Di Trapani F, Weiss N, Seebacher J, Dierker A, Schmutzhard J. Evaluation of an impedance-based method to monitor the insertion of the electrode array during cochlear implantation. Eur Arch Otorhinolaryngol 2024; 281:4121-4131. [PMID: 38564010 PMCID: PMC11266372 DOI: 10.1007/s00405-024-08584-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 02/26/2024] [Indexed: 04/04/2024]
Abstract
PURPOSE Cochlear implantation is a prevalent remedy for severe-to-profound hearing loss. Optimising outcomes and hearing preservation, and minimising insertion trauma, require precise electrode placement. Objective monitoring during the insertion process can provide valuable insights and enhance surgical precision. This study assesses the feasibility and performance of an impedance-based method for monitoring electrode insertion, compared to the surgeon's feedback. METHODS The study utilised the Insertion Monitoring Tool (IMT) research software, allowing for real-time measurement of impedance and evoked compound action potential (eCAP) during electrode insertion in 20 patient implantations. This enabled an impedance-based method to continuously assess the status of each electrode during the insertion process. The feasibility and performance was evaluated and compared to the surgeon's feedback approach. eCAP measurements focused merely on feasibility without searching specific responses. RESULTS The IMT demonstrated feasibility in measuring real-time impedances and eCAP during the insertion of the electrode array. The impedance-based method exhibited potential for accurately monitoring the insertion depth with a high success rate. However, further development is needed to improve the number of usable contacts. CONCLUSIONS Objective monitoring with the impedance-based method shows promise as a valuable tool to enhance the precision of cochlear implant electrode insertion respecting insertion distance estimation. The IMT research software proved feasible in recording real-time impedances and eCAP during electrode insertion. While this impedance-based method exhibits high success rates, further improvements are required to optimise the number of usable contacts. This study highlights the potential of objective monitoring techniques to enhance cochlear implantation outcomes.
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Affiliation(s)
- Timo M Gottfried
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Tyrol, Austria
| | - Pablo Galeazzi
- MED-EL Medical Electronics, Worldwide Headquarters, Fürstenweg 77a, Innsbruck, Tyrol, Austria
| | - Aline Föger
- MED-EL Medical Electronics, Worldwide Headquarters, Fürstenweg 77a, Innsbruck, Tyrol, Austria
| | - Daniel Dejaco
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Tyrol, Austria
| | - Andrea Tröger
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Tyrol, Austria
| | - Natalie Fischer
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Tyrol, Austria
| | - Veronika Innerhofer
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Tyrol, Austria
| | - Francesco Di Trapani
- MED-EL Medical Electronics, Worldwide Headquarters, Fürstenweg 77a, Innsbruck, Tyrol, Austria
| | - Nora Weiss
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Bochum, North Rhine-Westphalia, Bleichstraße 15, 44787, Bochum, Germany
- Department of Otorhinolaryngology, TUM School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Josef Seebacher
- Departement of Hearing, Speech and Voice Disorders, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Tyrol, Austria
| | - Angelika Dierker
- MED-EL Medical Electronics, Worldwide Headquarters, Fürstenweg 77a, Innsbruck, Tyrol, Austria
| | - Joachim Schmutzhard
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Tyrol, Austria.
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