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Originally published September 2, 2026
Last updated September 2, 2026
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Cochlear implants have long granted patients with profound hearing loss a new lease on life. Over the past two decades, cochlear implant candidacy has expanded greatly, and cochlear implants have increasingly become a viable option for patients with residual hearing and poor speech recognition.
However, manual surgical insertion of the cochlear implant array itself may damage the delicate inner-ear structures that surgeons hope to preserve — thus compromising patient outcomes and long-term implant performance.
Now, a robotically assisted cochlear implant insertion system approved for use in 2021 is literally steadying surgeons’ hands, helping them place cochlear implants with the precision and accuracy essential to optimal outcomes.
In 2024, Seiji Shibata, MD, PhD, an otolaryngologist with the USC Caruso Department of Otolaryngology – Head and Neck Surgery, part of Keck Medicine of USC, performed California’s first robotically assisted cochlear implant surgery on a California patient with profound hearing loss. He answers questions about the procedure and why he’s excited about its prospects.
Electrode arrays have become softer and more flexible. In the past, the electrodes were stiff and bulky, causing damage to the delicate structures of the inner ear. Growing evidence indicates that if you can preserve those inner-ear structures, outcomes with cochlear implants are better. So, there’s been a shift toward minimally invasive, or soft-insertion, techniques over the last decade or so.
We’re trying to place a very delicate electrode into an extremely small, confined space while operating under a microscope. Even with meticulous technique, manual insertion is inherently limited by physiological hand tremor and variability in insertion speed. If you move too slowly, natural hand tremor becomes more pronounced; if you move too quickly, you can generate excessive insertion forces. We know that these increased forces can traumatize the delicate structures of the inner ear, which is why minimizing insertion trauma remains such an important goal.
Robotically assisted insertion removes hand tremor and provides precise control over insertion speed, helping to reduce insertion forces on the delicate structures of the inner ear. By advancing the electrode at a slow, steady pace, it may reduce disruption within the cochlea and better preserve intracochlear structures, including hair cells and auditory nerve fibers. Although manual soft-insertion techniques can preserve residual hearing in many patients, long-term hearing preservation remains variable. Emerging evidence suggests that robotic-assisted insertion may further reduce intracochlear trauma and improve long-term hearing preservation, although additional clinical studies are needed to confirm these benefits.
At present, the greatest barriers to robotic-assisted electrode insertion are not concerns about safety but the challenges of introducing a new technology into clinical practice. Higher costs, a modest increase in operative time and the initial learning curve have limited its adoption. These challenges are likely to become less significant as the technology matures and further clinical studies clarify the comparative benefits of robotic-assisted and manual electrode insertion.
We treated the first patient in California with robotic-assisted electrode insertion in 2024. Although still limited to a select number of high-volume centers (34 nationwide), its use is expanding, and recent FDA approval for pediatric cochlear implantation may further support broader adoption as additional outcome data emerge.
Potentially, any patient undergoing cochlear implantation could benefit from robotic-assisted electrode insertion. Recent FDA approval for pediatric use is particularly promising, as preserving intracochlear structures may allow patients to benefit from future regenerative or molecular hearing therapies. Whether the greatest benefit will be seen in patients with residual hearing remains to be determined, although reducing insertion-related trauma, inflammation and scarring may improve long-term outcomes. Continued clinical experience and longer-term outcome data will help clarify which patient populations are most likely to benefit.
I think it’s important for people to know that this technology exists. Robotic-assisted insertion may provide a more controlled and consistent way to place the electrode, with the goal of minimizing trauma to the inner ear. If we can better preserve hearing and improve patient outcomes, that’s a meaningful step forward.
As the name suggests, the robot is a tool, not a replacement for the surgeon. Every critical step of the operation — from planning the procedure to exposing the cochlea round window and positioning the device — is still performed by the surgeon. The robot simply provides a steadier, more controlled electrode insertion, allowing the surgeon to pair clinical judgment with greater precision.
For referring physicians, the key message is that robotic-assisted electrode insertion is another option for patients who are candidates for cochlear implantation. While it is currently available at a number of major ear centers nationwide, the technology is designed to reduce insertion-related trauma without changing who qualifies for a cochlear implant. As more outcome data become available, it’s worth keeping in mind as an option to discuss with eligible patients.
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