Quantifying Soft‐Surgery in Cochlear Implantation: Multimodal Data From 30 International Specialists

OBJECTIVE: To quantify how surgical behavior influences intracochlear mechanical stress during cochlear implantation using objective multi-sensor data from a large cohort of specialist cochlear implant (CI) surgeons. METHODS: Thirty internationally recognized surgeons each performed bilateral insertions in mechanically representative artificial temporal bone models. Insertion force, pressure, and electrode kinematics were captured, and six trauma-related metrics were combined into a composite soft-surgery score. Associations with surgical experience, self-assessment, and handling behaviors were analysed using nonparametric statistics. RESULTS: Marked variability was observed across all metrics. Surgeons with < 50 lifetime insertions performed significantly worse than experienced colleagues. Self-assessment showed no correlation with objective outcomes. Excessively slow insertions and frequent electrode regrasping were associated with higher pressure exposure, greater force variation, and increased intracochlear implant motion. Post-insertion handling contributed substantially to intracochlear stress. CONCLUSION: Surgical behavior decisively influences intracochlear mechanical stress in CI. Steady, uninterrupted advancement at slow to moderate speed, avoidance of array regrasping, and careful post-insertion handling reduce mechanical load. Because self-assessment proved unreliable even among specialist CI surgeons, structured training with quantitative feedback and intraoperative monitoring is essential to refine soft-surgery technique, preserve residual hearing, and optimize hearing outcomes. LEVEL OF EVIDENCE: N/A.