{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T18:53:15Z","timestamp":1783018395292,"version":"3.54.6"},"reference-count":27,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2018,12,4]],"date-time":"2018-12-04T00:00:00Z","timestamp":1543881600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["T32 DC000027"],"award-info":[{"award-number":["T32 DC000027"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["aao-hnsfjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Otolaryngol.--head neck surg."],"published-print":{"date-parts":[[2019,2]]},"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>To describe a 3D\u2010printed middle ear model that quantifies the force applied to the modeled incus. To compare the forces applied during placement and crimping of a stapes prosthesis between the Robotic ENT Microsurgery System (<jats:italic>REMS<\/jats:italic>) and the freehand technique in this model.<\/jats:p><\/jats:sec><jats:sec><jats:title>Study Design<\/jats:title><jats:p>Prospective feasibility study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Robotics laboratory.<\/jats:p><\/jats:sec><jats:sec><jats:title>Subjects and Methods<\/jats:title><jats:p>A middle ear model was designed and 3D printed to facilitate placement and crimping of a piston prosthesis. The modeled incus was mounted to a 6\u2013degree of freedom force sensor to measure forces\/torques applied on the incus. Six participants\u20141 fellowship\u2010trained neurotologist, 2\u00a0neurotology fellows, and 3 otolaryngology\u2013head and neck surgery residents\u2014placed and crimped a piston prosthesis in this model, 3 times freehand and 3 times <jats:italic>REMS<\/jats:italic> assisted. Maximum force applied to the incus was then calculated for prosthesis placement and crimping from force\/torque sensor readings for each trial. Robotic and freehand outcomes were compared with a linear regression model.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Mean maximum magnitude of force during prosthesis placement was 126.4 \u00b1 73.6\u00a0mN and 105.0 \u00b1 69.4\u00a0mN for the freehand and robotic techniques, respectively (<jats:italic>P<\/jats:italic> =. 404). For prosthesis crimping, the mean maximum magnitude of force was 469.3 \u00b1 225.2\u00a0mN for the freehand technique and 272.7 \u00b1 97.4\u00a0mN for the robotic technique (<jats:italic>P<\/jats:italic> =. 049).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Preliminary data demonstrate that <jats:italic>REMS<\/jats:italic>\u2010assisted stapes prosthesis placement and crimping are feasible with a significant reduction in maximum force applied to the incus during crimping with the <jats:italic>REMS<\/jats:italic> in comparison with freehand.<\/jats:p><\/jats:sec>","DOI":"10.1177\/0194599818815144","type":"journal-article","created":{"date-parts":[[2018,12,4]],"date-time":"2018-12-04T04:23:47Z","timestamp":1543897427000},"page":"320-325","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Applied Force during Piston Prosthesis Placement in a 3D\u2010Printed Model: Freehand vs Robot\u2010Assisted Techniques"],"prefix":"10.1002","volume":"160","author":[{"given":"Christopher R.","family":"Razavi","sequence":"first","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery School of Medicine Johns Hopkins University Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul R.","family":"Wilkening","sequence":"additional","affiliation":[{"name":"Laboratory for Computational Sensing and Robotics Johns Hopkins University Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rui","family":"Yin","sequence":"additional","affiliation":[{"name":"Laboratory for Computational Sensing and Robotics Johns Hopkins University Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicolas","family":"Lamaison","sequence":"additional","affiliation":[{"name":"Laboratory for Computational Sensing and Robotics Johns Hopkins University Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Russell H.","family":"Taylor","sequence":"additional","affiliation":[{"name":"Laboratory for Computational Sensing and Robotics Johns Hopkins University Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John P.","family":"Carey","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery School of Medicine Johns Hopkins University Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francis X.","family":"Creighton","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery School of Medicine Johns Hopkins University Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2018,12,4]]},"reference":[{"key":"e_1_2_10_2_1","first-page":"31","article-title":"A 15\u2010year report on 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