Clinical Results of Robot-assisted Versus Manual Otosclerosis Surgery

Objective: To evaluate the functional results of robot-assisted laser guidance in otosclerosis surgery. Study design: Retrospective case-control study. Setting: Otology/neurotology tertiary referral clinic. Patients: Patients operated for primary microscopic stapes surgery performed by a single surgeon from August 2018 to October 2022 using the robot-assistance or the manual technique. Interventions: Primary otosclerosis surgeries with robot-assistance or the conventional manual technique. Main outcome measures: Evaluation of the audiologic outcome of air conduction, bone conduction, air-bone gap and speech recognition threshold at 3 months and 1 year postoperative. Intraoperative observations, prosthesis choice, and operation duration were collected. Results: A total of 74 patients were operated on for otosclerosis, of which 45 patients were operated on with robot-assistance, and 46 with the conventional manual technique. A reduction of laser shots (2 vs. 3) was necessary to perform footplate fenestration in the robot-assisted group ( P <0.02). Both groups had similar audiometric outcomes. In the robot-assisted group, successful closure of an air-bone gap of <15 dB was achieved in 94% of patients at 3 months, and in 100% at 1 year, compared with 92% at 3 months ( P >0.99) and 97% at 1 year ( P <0.48) in the manual group. Air-bone gap closure of <10 dB was attained in 86% and 82% at 3 months ( P <0.76) and 97% and 93% at 12 months ( P <0.61) in the robot-assisted and manual groups, respectively. Both groups improved postoperatively in air conduction thresholds and air-bone gaps while maintaining a stable bone conduction. Conclusion: This study reports the use of robot assistance as a laser holder for otosclerosis surgery, which indicates similar audiologic outcomes and no major complications. Robot-assisted otosclerosis surgery is a reliable and safe technique.