A steadier hand

Gantz has trained a long line of future surgeons in the art of threading tiny electrode wires through the delicate cochlea. Among those former residents was Hansen, who joined the Carver College of Medicine faculty in 2003 and last year took over for Gantz as chair of the Department of Otolaryngology. 

Of their many key research findings, Hansen and Gantz have proven that the slower those electrodes are pushed through the cochlea, the less trauma occurs to the high-risk sections of the inner ear.  

“The inner ear has a lining that is very reactive to damage, it’s only a few cells thick. And we don’t have any haptic control [technology that simulates the sense of touch] when we’re completing these procedures. There is no sensation that we’re up against the edges or we’re causing any issues,” says Gantz, UI professor of otolaryngology and neurosurgery.

Studies show that between 15% to 50% of implant recipients may experience an additional loss of their natural hearing after surgery. By mitigating the damage caused by the electrode scraping against the walls of the cochlea, more functionality can be preserved in patients who have residual hearing.  

"What Bruce and the team at Iowa have demonstrated is that any acoustic hearing you can save is really helpful for patients, especially to hear complex sounds, music, and in noisy situations," Hansen says. "It helps their brain process sound, and more importantly, they don't need as much cognitive effort to hear and understand." 

With that goal in mind, Hansen and Kaufmann, a former resident in his lab with a background in biomedical engineering, collaborated on a project to standardize electrode insertion and make the maneuver more precise. Their solution was the creation of a small robotic device to help guide the electrode through the spiraling cochlea, and in 2015 they founded a spin-out company called iotaMotion to develop the tool, named iotaSoft.  

The recent FDA approval of the device will help the team cross a major hurdle in bringing their product to the market after years of research and development. 

Today, the privately held company has grown into a nine-person operation based in Iowa City, with Hansen serving as chief medical officer and Kaufmann serving as president and leading research and development. The company has raised more than $4.5 million in private financing, and it has received more than $4 million in grant support from the NIH and the National Science Foundation.

During cochlear implant surgery, the cigar-sized robotic device is affixed to a patient's head with small screws. The surgeon uses a fine, curved tool to help position the electrodes through the incision behind the ear, then presses a foot pedal that begins the robot's slow, motorized insertion process. At a rate of just 0.1 millimeters per second, the robot nudges the electrode into the inner ear with a gentle precision that surpasses even the most steady-handed surgeon. 

"My hand, even though I've done this maybe 3,000 times or more, is not as good as a micromotor," says Gantz. "Electrodes that are the least damaging are very thin, so it's like putting a wet piece of spaghetti in a tube. What the robot does is stabilizes it." 

Last fall, Gantz became the first doctor in the world to perform a robot-assisted cochlear implant surgery during a clinical trial at Iowa for iotaMotion's device. Since then, Gantz has used it to successfully guide more than 15 cochlear implant procedures.  

The device is one of several new technologies in the works at iotaMotion, which is also developing a robot-assisted control system that allows clinicians to reposition previously implanted electrodes to account for new hearing loss throughout the lifetime of their patients without the need for additional surgery.