On the operating table, a sexagenarian from the Riviera, suffering from severe deafness; sleepy, he will soon benefit from a cochlear implantation intended to improve his access to sounds.
At the helm, Pr Nicolas Guevara, ENT at the IUFC (University Institute of the face and neck) in Nice. The treatment itself is familiar to this well-known specialist in deafness surgery: more than 20 years have passed since the development of the cochlear implant, an active implantable device (for life), comparable to a pacemaker for the heart.
If the block receives many specialists that day (some of them from abroad), it is because of the intervention that Pr Guevara realized the existence of a unique character; he will be assisted in his actions by… a robot. A robot completely conceived and designed for minimally invasive otological surgery: the RobOtol®. A (huge) gem of technology – worth 300,000 to 400,000 euros (1) – with which only a few establishments in France (13 in total) are equipped, including the establishment in Nice.
“The ear is very sensitive, it has to be perfect, firm.”
While the operation takes place in a religious silence accompanied by a few comments from Professor Guevara, a young surgeon in training, describes the stages to us. “He made an incision behind the ear then carefully ground, with the help of the robot, the bone behind which are all the hearing organs: the ossicles that amplify the sound and the cochlea, which actually gives -way to hear by changing the mechanical message of the air. into a nervous electrical message that our brain can hear. This is a question that passes behind the auditory canal to reach the eardrum. There, we will recognize, under the microscope, all the elements and get your bearings, avoiding all the bones , the roots that should not be touched: the anvil (bones that transmit vibrations produced by sound waves, editor’s note)the facial nerve…”
Holding very good instruments, and under robotic guidance, Professor Guevara will be able, once he reaches the anatomical target, to place the implant very slowly, regularly, without tremors and above all without jolts. “These are the jolts that, a priori, are responsible for cell damage in the cochlea. You have to be as traumatic as possible to get the best long-term results.” The implant is positioned with an accuracy of 5 microns, hearing does not support approximation. “The ear is very sensitive, it has to be perfect, firm.”
At the end of the intervention, Pr Nicolas Guevara returns to the issues related to this innovation.
You just had a cochlear implant. What next?
We installed the inner part. After taking some measurements to see if the nerve and the implant are working, the outer part can be placed: a simple earloop with a small antenna that is magnetized, through the skin, to the implant. The patient will only need to put it on in the morning when he wakes up and take it off when washing or sleeping, to put it on to recharge.
Who are the affected patients?
All adults who become deaf as a result of infection, disease, trauma or, usually, no known cause, but more likely due to congenital or family deficiency.
How many such interventions do you perform each year, and can they all be performed with the help of a robot?
Robot-assisted cochlear implantation is currently in research and development. But we hope to treat with this technology, in the near future, all patients who have become deaf and need a cochlear implant. That means about thirty per year in the IUFC.
Can children benefit from this?
Not on a date. I insist, this is an innovation, currently being tested, which has not yet provided proof of its benefits. A national research program begins in which Nice participates; it will compare robot-assisted cochlear implantation versus conventional surgery, in terms of hearing outcomes.
1. The cost of the robot was brought up to 150,000 euros by the Departmental Council, 150,000 euros by Nice University Hospital and 100,000 euros by Oticon Medical (manufacturer of cochlear implants based in Vallauris) within the framework of a scientific partnership.