Cochlear implant surgery is one of the most complex and precise ear surgeries for hearing loss. During the operation, a thin electrode with a diameter of only 0.3-0.4 millimeters is inserted into the cochlea, the inner ear, explained Dr. László Tamás, university professor and director of the Department of Otorhinolaryngology, Head and Neck Surgery Clinic. The aim of the procedure is for the device to directly stimulate the nerve pathways instead of the damaged hair cells, thus ensuring the experience of hearing. In special cases, the implant can also function as a hearing aid in the still-hearing part of the cochlea, or as a cochlear implant where the hair cells have died. The clinic director added that the biggest challenge during the operation is the gentle and precise placement of the electrode, as the delicate structures of the inner ear are extremely sensitive and even the slightest damage can affect the quality of hearing.
Robotic surgery is a breakthrough in this area. The clinic has already tested another robotic surgical device in four operations, and now they have received a new type of robot for temporary use that is smaller and even more precise than the previous one.
The robotic arm is capable of inserting the electrode with a precision unattainable by the human hand, at a speed of up to 0.1 millimeters per second, explained Dr. Gábor Polony, associate professor and surgeon performing the procedures. He added that this speed is invisible to the naked eye.
The computer-controlled system provides feedback on depth and position at every moment of insertion, while the operator controls the process using a foot pedal. Thus, the procedure is performed under the control of the surgeon, but with the support of technology, said Dr. Gábor Polony. Although the use of the robot slightly extends the duration of the surgery—by an average of about 15 minutes per ear—the long-term benefits are clear.
The first surgery using the new robotic surgical device was performed at the clinic on a four-year-old child who had the implant inserted in both ears. The procedure was successful, and the young patient has since undergone complex rehabilitation. This surgery has since been followed by further successful procedures.
Robotic technology opens up new horizons not only for children, but also for adults and the elderly, added Dr. László Tamás. In many cases, hearing loss in old age reaches a level where hearing aids no longer provide adequate speech comprehension. In such cases, a cochlear implant can be the solution, implanted even more gently with the support of robotic surgery. For elderly patients, this means not only regaining their hearing, but also regaining social relationships, communication, and quality of life, as hearing loss increases isolation, depression, and cognitive decline.
Whether the implant is inserted using a robot or conventional methods is decided on the basis of individual considerations between specialists and patients, taking into account a variety of factors.
The technology now introduced at the clinic was developed by a leading implant manufacturer and was among the first in Europe to be tested by the Department of Otorhinolaryngology, Head and Neck Surgery Clinic. The manufacturer is planning multicenter research with several international centers, for which the clinic will also be able to provide data, said Dr. László Tamás. This is a great opportunity not only from a scientific but also from a clinical point of view, as long-term data will help assess the extent to which robotic surgery improves hearing preservation and rehabilitation outcomes.