Robot-assisted endoscopy in cholesteatoma surgery of the middle ear: a feasibility and safety comparative study with 3-year follow-up.

PURPOSE: Otologic surgical techniques are trending toward minimally invasive approaches. Middle ear endoscopy offers excellent anatomical visualization but requires one-handed dissection, limiting ergonomics for surgeons trained in bimanual techniques. The integration of a robotic arm allows the endoscope to be held in a stable position while freeing both hands for dissection. The purpose of this study was to evaluate the feasibility, safety, and medium-term outcomes of robot-assisted endoscopic cholesteatoma surgery compared with conventional microscopic surgery. METHODS: Retrospective comparative single-center study including 40 adult patients operated between 2019 and 2022. Outcomes included audiometric results and DWI-MRI evaluation at 3-year follow-up. RESULTS: Tympanic healing was complete in all cases, with no perioperative or postoperative complications related to the robot. After exclusion of cophotic ears, audiometric outcomes were broadly comparable for most parameters. Residual cholesteatoma was detected in 19% of the robot-assisted group and 15.8% of the microscope group (p = 1.00). CONCLUSION: Robot-assisted endoscopy appears to be a feasible and safe technique, combining the advantages of endoscopy with those of bimanual surgery. However, given the limited sample size and retrospective design, the present study was not powered to demonstrate non-inferiority or equivalence between techniques. Larger prospective multicenter studies are required before definitive conclusions regarding comparative efficacy can be drawn.