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Robotic pullback technique of a precurved cochlear-implant electrode array using real-time impedance sensing feedback

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International Journal of Computer Assisted Radiology and Surgery Aims and scope Submit manuscript

Abstract

Purpose

During traditional insertion of cochlear implant (CI) electrode arrays (EAs), surgeons rely on limited tactile feedback and visualization of the EA entering the cochlea to control the insertion. One insertion approach for precurved EAs involves slightly overinserting the EA and then retracting it slightly to achieve closer hugging of the modiolus. In this work, we investigate whether electrical impedance sensing could be a valuable real-time feedback tool to advise this pullback technique.

Methods

Using a to-scale 3D-printed scala tympani model, a robotic insertion tool, and a custom impedance sensing system, we performed experiments to assess the bipolar insertion impedance profiles for a cochlear CI532/632 precurved EA. Four pairs of contacts from the 22 electrode contacts were chosen based on preliminary testing and monitored in real time to halt the robotic insertion once the closest modiolar position had been achieved but prior to when the angular insertion depth (AID) would be reduced.

Results

In this setting, the open-loop robotic insertion impedance profiles were very consistent between trials. The exit of each contact from the external stylet of this EA was clearly discernible on the impedance profile. In closed-loop experiments using the pullback technique, the average distance from the electrode contacts to the modiolus was reduced without greatly affecting the AID by using impedance feedback in real time to determine when to stop EA retraction.

Conclusion

Impedance sensing, and specifically the access resistance component of impedance, could be a valuable real-time feedback tool in the operating room during CI EA insertion. Future work should more thoroughly analyze the effects of more realistic operating room conditions and inter-patient variability on this technique.

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Acknowledgements

The authors thank Peter Gibson of Cochlear Ltd. for providing the EAs used in these experiments.

Funding

This work was supported in part by the National Science Foundation Graduate Research Fellowship under DGE-1445197/1937963.

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Authors and Affiliations

  1. Department of Mechanical Engineering, Vanderbilt University, Nashville, TN, USA

    Katherine E. Riojas, Trevor L. Bruns, Josephine Granna & Robert J. Webster III

  2. Department of Otolaryngology, Medical University of South Carolina, Charleston, SC, USA

    Robert F. Labadie

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  1. Katherine E. Riojas
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  2. Trevor L. Bruns
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Corresponding author

Correspondence to Katherine E. Riojas.

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Conflict of interest

R.F.L. is a consultant for Advanced Bionics and Medtronic. No other conflicts of interest.

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Riojas, K.E., Bruns, T.L., Granna, J. et al. Robotic pullback technique of a precurved cochlear-implant electrode array using real-time impedance sensing feedback. Int J CARS 18, 413–421 (2023). https://doi.org/10.1007/s11548-022-02772-3

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