The Feasibility of the Three-Dimensional Footswitch-Operated Robotic Arm Exoscope for Cochlear Implant Surgery

OBJECTIVE: To compare the three-dimensional (3D) footswitch-operated robotic arm exoscope with the operating microscope (OM) in cochlear implant surgery. STUDY DESIGN: Matched case–control study. PATIENTS: Cochlear implantation was performed with the exoscope on unselected patients with normal temporal anatomy. The control group that underwent cochlear implantation with the OM was case matched with respect to age, anatomy, surgical technique, and type of anesthesia. INTERVENTIONS: Cochlear implantation performed with the 3D exoscope. MAIN OUTCOME MEASURES: Surgical time, occupation of the operation theater, surgical results, and user experience evaluated by a questionnaire. RESULTS: Eleven patients (13 ears) were successfully operated on with the exoscope. In the exoscope group, we observed one minor intraoperative complication, where the middle dura was exposed during mastoidectomy. Although no clear preference was evident for either device in the overall rating, the subdomain rating revealed that the exoscope’s image quality was deemed inferior, especially at higher magnifications where pixelation became noticeable. The exoscope received higher scores for usability, particularly excelling in terms of surgeon’s ergonomic and comfortability. There was a statistically significant difference in mean surgical time, 146 and 129 min for the exoscope and OM group, respectively. CONCLUSIONS: Cochlear implant surgery was found to be feasible with a 3D exoscope. However, there is a learning curve to overcome regarding handling and the different quality of the image. The exoscope provides better ergonomics for the surgeon.