Early Clinical Experience With Robot-Assisted Electrode Insertion in Cochlear Implantation Using the Otoarm-Otodrive System.

IMPORTANCE: Manual cochlear implant (CI) electrode insertion remains surgeon-dependent and may contribute to intracochlear trauma. Robotic-assisted systems, such as the new Otoarm-Otodrive, offer motorized control at ultra-slow speeds that aim to minimize force fluctuations and pressure changes, potentially improving hearing preservation and surgical consistency. OBJECTIVE: To describe the institutional experience, surgical workflow integration, and feasibility of robot-assisted cochlear implantation (CI) using the Otoarm-Otodrive system. DESIGN: Retrospective descriptive study of 50 consecutive robot-assisted CI cases. SETTING: Tertiary referral otology center in Canada. PARTICIPANTS: Fifty Adult patients undergoing cochlear implantation without cochlear malformation or ossification using a MED-EL device from January to October 2025. INTERVENTION: Robot-assisted cochlear electrode array insertion using the Otoarm-Otodrive (MED-EL) system. MAIN OUTCOME MEASURES: Feasibility (setup and insertion times), insertion depth, intraoperative challenges, and integration into operative workflow. RESULTS: The additional time for robot setup and alignment averaged 374 seconds. Mean electrode insertion duration, performed at a standardized rate of 0.1 mm/second, was 444 seconds. Postoperative Otoplan analysis in 30 cases demonstrated a mean angular insertion depth of 575°. No major complications such as facial nerve palsy or infections, and no device-related complications occurred. All but 1 case achieved full insertion. CONCLUSIONS: Robot-assisted cochlear electrode insertion using the Otoarm-Otodrive system is safe, reproducible, and easily integrated into standard CI workflow. RELEVANCE: This first North American experience in using the Otoarm-Otodrive system demonstrates the feasibility of robotic cochlear implant insertion as a step toward achieving atraumatic implantation. Future studies will assess hearing preservation benefits and cost-effectiveness for broader adoption.