Abstract
Purpose
To evaluate the forces involved in different manipulations, manual or robot-assisted, applied to the ossicular chain, on normal temporal bones and on an anatomical model of otosclerosis.
Methods
Thirteen cadaveric temporal bones, with mobile footplates or with footplates that were fixed using hydroxyapatite cement, were manipulated, manually or using a robotic arm (RobOtol®). “Short contact” of a mobile footplate was the weakest interaction on the incus. “Long contact” was the same manipulation held for 10 s. “Mobilization” was the smallest visualized movement of the mobile footplate, or the movement necessary to regain mobility of the fixed footplate. A six-axis force sensor (Nano17, ATI) measured the maximal peak of forces, summation of forces applied, and yank.
Results
Maximal forces during short (~4 mN) and long contact (~15 mN) were similar for manual and robot-assisted manipulations. For manual manipulation, yank measured during long contact was twice as high compared to robot-assisted manipulation: 6 ± 2.4 (n = 5) and 3 ± 1.3 mN/s (n = 5), respectively (mean ± SD, p < 0.02). For mobilization of the mobile footplate, maximal forces during mobilization were similar during manual and robot-assisted manipulations, respectively: 12 ± 2.5 (n = 6) and 19 ± 7.6 mN (n = 7). Compared with mobilization of a mobile footplate, mobilization of a fixed footplate required ~ 60 and ~ 27 times higher maximal forces for manual and robot-assisted manipulations, respectively: 724 ± 366.4 and 507 ± 283.2 mN. Yank was twice as high during manual manipulation compared to robot-assisted manipulation (p < 0.05).
Conclusion
Robot-assisted manipulation of the ossicular chain was reliable. Our anatomical model of otosclerosis was successfully developed requiring higher forces for stapes mobilization.
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Acknowledgements
We thank the Société Française d’Otorhinolaryngologie et de chirurgie de la face et du cou for their financial support (HD).
Funding
Fondation pour l’Audition (Hearing Institute starting grant), Société Française d’Otorhinolaryngologie et de chirurgie de la face et du cou, Agence Nationale de la Recherche Robocop ANR-19-CE19-0026-02.
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SM is an employee from Collin Orl Ltd. Other authors report no conflict of interest.
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Daoudi, H., Torres, R., Mazalaigue, S. et al. Analysis of forces during robot-assisted and manual manipulations of mobile and fixed footplate in temporal bone specimens. Eur Arch Otorhinolaryngol 278, 4269–4277 (2021). https://doi.org/10.1007/s00405-020-06553-z
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DOI: https://doi.org/10.1007/s00405-020-06553-z