The Impact of Robot-Assisted Electrode Insertion on Cochlear Implant Surgery Time: A Retrospective Study

Objective: To compare operative times and audiometric outcomes between robotic-assisted cochlear implantation (CI) and manual insertion. Study design: Retrospective study. Setting: Tertiary academic center. Patients: Patients undergoing CI between October 2022 and October 2024. Interventions: Robotic-assisted or manual CI. Main outcome measures: Operative time and audiometric outcomes between techniques. Results: Fifty-one patients (17 robotic-assisted, 34 manual) were included. Demographics were similar between cohorts, although the robotic cohort was older {median [interquartile range (IQR)] 74.4 y [56.1 to 83.1] vs. 60.1 y [42.3 to 72.5], P =0.025}. Operative time did not differ significantly; robotic-assisted cases showed a median increase of ~20 minutes with substantial interquartile overlap and no statistically significant difference ( P =0.171). Preoperatively, the robotic cohort demonstrated higher aided speech perception [consonant-nucleus-consonant word (CNC-w) 22% vs. 0%, P =0.003; (CNC phoneme) CNC-p 45% vs. 15%, P =0.014; AzBio-Quiet 28% vs. 5%, P =0.006] and better low-frequency thresholds (250 to 500 Hz; 60 vs. 72.5 dB HL, P =0.003), whereas unaided speech reception threshold (SRT), word recognition score (WRS), and pure-tone average at 0.5, 1, 2, and 3 kHz (PTA) did not differ. Postoperatively, both cohorts improved, with no significant between-group differences at 3, 6, or 12 months or most recent follow-up for SRT, CNC-w, CNC-p, AzBio-Quiet, or aided PTA. Conclusions: Robotic-assisted CI electrode insertion was associated with a limited, non-statistically significant operative time increase and similar short-term to intermediate-term audiometric outcomes compared with manual insertion.