{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T19:10:53Z","timestamp":1792782653463,"version":"4.5.0"},"reference-count":22,"publisher":"Springer Science and Business Media LLC","license":[{"start":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T00:00:00Z","timestamp":1789776000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T00:00:00Z","timestamp":1789776000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"University of Szeged","id":[{"id":"https:\/\/ror.org\/01pnej532","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur Arch Otorhinolaryngol"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>\n                      Cochlear implantation in congenital inner ear malformations can be technically challenging due to the atypical anatomy which can limit electrode selection, trajectory, and insertion depth. Although high-resolution CT\/MRI and planning tools (e.g., OTOPLAN\n                      <jats:sup>\u00ae<\/jats:sup>\n                      ) support preoperative assessment, severe malformations may require additional validation. We evaluated whether robot-assisted insertion improves insertion performance in malformed cochleae using patient-specific 3D models.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      High-resolution CT and\/or MRI from 8 paediatric candidates were used to reconstruct and 3D print 16 cochleae (malformed cochleae plus one anatomically normal control with eighth nerve aplasia, as applicable). Four electrode arrays (MED-EL Medium, MED-EL Compressed, MED-EL Flex24, and Cochlear Straight) were inserted by an expert surgeon (P1), a novice surgeon (P2), and a robotic system (RobOtol\n                      <jats:sup>\u00ae<\/jats:sup>\n                      , R1). Outcomes were insertion completeness (complete\/incomplete) and ease (easy\/hard). Data were analysed using Firth\u2019s penalized logistic regression and classification tree analysis. Preoperative prediction by P1 alone versus P1\u2009+\u2009OTOPLAN\n                      <jats:sup>\u00ae<\/jats:sup>\n                      was compared using standard classification metrics.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Electrode type and cochlear anatomy were the primary determinants of insertion outcomes. Electrode arrays with shorter active lengths (MED-EL Compressed) demonstrated higher insertion completeness in anatomically restricted malformed cochleae, whereas Flex24 and Cochlear Straight showed reduced completeness in restrictive hypoplastic cochleae. Operator identity, including robotic assistance, had minimal impact; ease was generally high. OTOPLAN\n                      <jats:sup>\u00ae<\/jats:sup>\n                      assisted planning improved prediction performance and reduced false-negative assessments.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In malformed cochleae, insertion completeness was influenced primarily by cochlear morphology and electrode characteristics within the outcome measures assessed. Patient-specific 3D models provide a useful platform for electrode\u2013anatomy compatibility assessment and preoperative planning; however, clinical validation incorporating tonotopic coverage, audiological outcomes, and objective robotic performance metrics is warranted.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00405-026-10611-3","type":"journal-article","created":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T22:46:34Z","timestamp":1789771594000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Evaluation of manual and robot-assisted electrode placement in malformed cochleae using imaging-based patient specific 3D models"],"prefix":"10.1007","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4185-7292","authenticated-orcid":false,"given":"Fiona Anna","family":"Moln\u00e1r","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M\u00e1ria","family":"Matuz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zolt\u00e1n","family":"Tobi\u00e1s","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zsolt","family":"Geretovszky","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zs\u00f3fia","family":"Bere","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haadi","family":"Mollabux","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roland","family":"Nagy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L\u00e1szl\u00f3","family":"Rov\u00f3","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u00c1d\u00e1m","family":"Perenyi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,9,19]]},"reference":[{"issue":"3","key":"10611_CR1","doi-asserted-by":"publisher","first-page":"e276","DOI":"10.1097\/MAO.0000000000003507","volume":"43","author":"RD Monsanto","year":"2022","unstructured":"Monsanto RD, Bento RF, Paiva LR, Brito R, Leal MC (2022) Cochlear implantation outcomes in patients with inner ear malformations: a systematic review. 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(Sydney, Australia). The RobOtol\n                      \u00ae\n                      robotic system (Collin Medical, Bagneux, France) was used for experimental insertions. The manufacturers had no role in study design, data acquisition, data analysis, interpretation of results, or manuscript preparation.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This work has not been previously published or submitted elsewhere. The corresponding author has read the author\u2019s guidelines.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"All procedures were conducted in accordance with institutional and national ethical standards and with the Declaration of Helsinki. The study was approved by the ETT-TUKEB committee (Approval No. BM\/4562-1\/2024).","order":3,"name":"Ethics","label":"Ethical approval","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Each author listed on the manuscript has seen and approved the submission of this version of the manuscript and takes full responsibility for the manuscript.","order":4,"name":"Ethics","label":"Consent for publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"was obtained from the participants and or from legal guardian.","order":5,"name":"Ethics","label":"Written informed consent","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors have no conflict of interest to disclose.","order":6,"name":"Ethics","label":"Conflict of interest","group":{"name":"EthicsHeading","label":"Declarations"}}]}}