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Recent investigations focused on the optimization of atraumatic cochlear implant surgery have highlighted the relevance of the electrode array (EA) insertion trajectory. This is particularly studied in the context of minimally-invasive “keyhole” and robotic-assisted approaches, e.g. to avoid injuring structures inside and outside the cochlea. However, little is known about the natural, manual movements and trajectory followed during the insertion process. The present work illustrates the orientation changes within the trajectory a surgeon follows during insertions of EAs into a human cadaveric cochlea. Methods: An EA insertion tool equipped with a gyroscope was developed in our laboratory. During the insertion trials, the gyroscope captures the tool’s spatial orientation. A human head specimen and a single EA were used to perform insertions into a cochlea. A cochlear implant surgeon performed all insertion trials. The recorded orientations were compared to the initial orientation upon cochlea entry to assess the surgeon’s range of motion by calculating the angle between orientation vectors. Results: Fifteen EA insertions were performed with a median maximal deviation from the initial orientation of 7.2° (5.3 -11.1°) across trials. The largest orientation changes were seen towards the last half of each insertion trial. A negative relationship between degree of axis change and number of insertion trial was observed (r = -0.5). Conclusion: Manual EA insertions into a cadaveric cochlea revealed an insertion trajectory with maximum orientation changes of approximately &lt; 10° degrees. The observed trend on decreasing range of motion with increasing number of insertion trials may be attributed to surgeon’s familiarization with the insertion trajectory for this specific specimen but other contributing factors (e.g. EA softening) need to be further elucidated with several EAs. Future evaluations can help determine if this orientation change is influenced by surgeon expertise.

Illustrating orientation changes of the insertion trajectory during cochlear implant electrode array insertion