Early Clinical Experience With Robot-Assisted Electrode Insertion in Cochlear Implantation Using the Otoarm-Otodrive System.

IMPORTANCE

Manual cochlear implant (CI) electrode insertion remains surgeon-dependent and may contribute to intracochlear trauma. Robotic-assisted systems, such as the new Otoarm-Otodrive, offer motorized control at ultra-slow speeds that aim to minimize force fluctuations and pressure changes, potentially improving hearing preservation and surgical consistency.

OBJECTIVE

To describe the institutional experience, surgical workflow integration, and feasibility of robot-assisted cochlear implantation (CI) using the Otoarm-Otodrive system.

DESIGN

Retrospective descriptive study of 50 consecutive robot-assisted CI cases.

SETTING

Tertiary referral otology center in Canada.

PARTICIPANTS

Fifty Adult patients undergoing cochlear implantation without cochlear malformation or ossification using a MED-EL device from January to October 2025.

INTERVENTION: Robot-assisted cochlear electrode array insertion using the Otoarm-Otodrive (MED-EL) system.

MAIN OUTCOME MEASURES: Feasibility (setup and insertion times), insertion depth, intraoperative challenges, and integration into operative workflow.

RESULTS

The additional time for robot setup and alignment averaged 374 seconds. Mean electrode insertion duration, performed at a standardized rate of 0.1 mm/second, was 444 seconds. Postoperative Otoplan analysis in 30 cases demonstrated a mean angular insertion depth of 575°. No major complications such as facial nerve palsy or infections, and no device-related complications occurred. All but 1 case achieved full insertion.

CONCLUSIONS

Robot-assisted cochlear electrode insertion using the Otoarm-Otodrive system is safe, reproducible, and easily integrated into standard CI workflow.

RELEVANCE: This first North American experience in using the Otoarm-Otodrive system demonstrates the feasibility of robotic cochlear implant insertion as a step toward achieving atraumatic implantation. Future studies will assess hearing preservation benefits and cost-effectiveness for broader adoption.