Suitable Electrode Choice for Robotic-Assisted Cochlear Implant Surgery: A Systematic Literature Review of Manual Electrode Insertion Adverse Events

Paul Van de Heyning, Peter Roland, Luis Lassaletta, Sumit Agrawal, Marcus Atlas, Wolf-Dieter Baumgartner, Kevin Brown, Marco Caversaccio, Stefan Dazert, Wolfgang Gstoettner, Rudolf Hagen, Abdulrahman Hagr, Greg Eigner Jablonski, Mohan Kameswaran, Vladislav Kuzovkov, Martin Leinung, Yongxin Li, Andreas Loth, Astrid Magele, Robert MlynskiJoachim Mueller, Lorne Parnes, Andreas Radeloff, Chris Raine, Gunesh Rajan, Joachim Schmutzhard, Piotr H Skarzynski, Piotr H Skarzynski, Georg Sprinzl, Hinrich Staecker, Timo Stöver, Dayse Tavora-Viera, Vedat Topsakal, Shin-Ichi Usami, Vincent Van Rompaey, Nora M Weiss, Wilhelm Wimmer, Mario Zernotti, Javier Gavilan

Research output: Journal article (peer-reviewed)Review article

8 Citations (Scopus)


Background and Objective: The cochlear implant (CI) electrode insertion process is a key step in CI surgery. One of the aims of advances in robotic-assisted CI surgery (RACIS) is to realize better cochlear structure preservation and to precisely control insertion. The aim of this literature review is to gain insight into electrode selection for RACIS by acquiring a thorough knowledge of electrode insertion and related complications from classic CI surgery involving a manual electrode insertion process.

Methods: A systematic electronic search of the literature was carried out using PubMed, Scopus, Cochrane, and Web of Science to find relevant literature on electrode tip fold over (ETFO), electrode scalar deviation (ESD), and electrode migration (EM) from both pre-shaped and straight electrode types.

Results: A total of 82 studies that include 8,603 ears implanted with a CI, i.e., pre-shaped (4,869) and straight electrodes (3,734), were evaluated. The rate of ETFO (25 studies, 2,335 ears), ESD (39 studies, 3,073 ears), and EM (18 studies, 3,195 ears) was determined. An incidence rate (±95% CI) of 5.38% (4.4-6.6%) of ETFO, 28.6% (26.6-30.6%) of ESD, and 0.53% (0.2-1.1%) of EM is associated with pre-shaped electrodes, whereas with straight electrodes it was 0.51% (0.1-1.3%), 11% (9.2-13.0%), and 3.2% (2.5-3.95%), respectively. The differences between the pre-shaped and straight electrode types are highly significant (p < 0.001). Laboratory experiments show evidence that robotic insertions of electrodes are less traumatic than manual insertions. The influence of round window (RW) vs. cochleostomy (Coch) was not assessed.

Conclusion: Considering the current electrode designs available and the reported incidence of insertion complications, the use of straight electrodes in RACIS and conventional CI surgery (and manual insertion) appears to be less traumatic to intracochlear structures compared with pre-shaped electrodes. However, EM of straight electrodes should be anticipated. RACIS has the potential to reduce these complications.

Original languageEnglish
Article number823219
Pages (from-to)823219
JournalFrontiers in Surgery
Publication statusPublished - 24 Mar 2022


  • electrode migration
  • pre-shaped electrode
  • robotic assisted cochlear implant surgery
  • scalar deviation
  • straight electrode
  • tip fold-over

ASJC Scopus subject areas

  • Surgery


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