Author(s)
Alex Z. Graboyes
Kevin Wong, MD
Jason A. Brant, MD
Affiliation(s)
University of Pennsylvania;
Abstract:
Objective: To review robotic systems currently in use for otologic and neurotologic procedures.
Data sources: Pubmed, Embase, and Cochrane Library were searched using the following search query: (robotics OR "robotic surgery" OR "robot-assisted surgery") AND ("ear surgery" OR "mastoid surgery" OR "cochlear implants" OR "lateral skull base surgery" OR otology OR neurotology) NOT (TORS OR transoral OR thyroid OR otolaryngology).
Study selection: Included articles were those describing a clinical usage of robotics applied to neurotologic and otologic procedures in live patients. Exclusion criteria included poster abstracts, review papers, studies performed on non-living subjects, if no surgical intervention was performed, and non-English articles. PRISMA guidelines were followed for article review and selection.
Data extraction: Initial search conducted in September 2023 produced 236 results (Pubmed:124, Embase: 97, Web of Science:15). Sixty-one duplicates were removed, leaving 175 studies. 71 underwent full text review, and 59 studies were excluded. An additional 4 were included from bibliographies of reviewed papers leaving 16 papers included in the final review.
Data synthesis: The 16 studies included 191 pediatric and adult subjects and six distinct robotic systems: RobOtol (7 studies), HEARO (4), Rosa (1), RoboticScope (2), IotaSoft (1), and Aesculap Aeos (1). A total of 58 participants underwent middle ear procedures, 132 underwent cochlear implantation, and 1 underwent mastoidectomy Three studies reported complications (5 participants). Meta-analysis was not possible due to the heterogenous nature and quality of the outcomes reported.
Conclusions: While still in early development, several robotic systems for otologic applications have progressed to clinical testing. Here we review the available literature and summarize reported patient outcomes.
Professional Practice Gap & Educational Need: Major progress has been made in regard to robotics across all subspecialities in recent years. In the field of neurotology, over the last six years, there has been a move from strictly ex-vivo studies to clinical studies, demonstrating reproducible results. This presents a systematic review of all the systems currently in use and provide the types of surgeries they were used in, how they were utilized, and the outcomes.
Learning Objective: To know what robotic systems are being used in neurotology, how each of the systems are utilized in each respective procedure, and to understand the results produced.
Desired Result: For providers to have a better understanding of robotics in the field of neurotology, and considerations of usage of such systems when they become more widely available.
Level of Evidence – Level III
Indicate IRB or IACUC : Exempt