Cochlear Implant Surgery: Robots, HEARO and ABB

Cochlear implant surgery puts a thin electrode array inside the spiral of the inner ear so that a person with severe or profound deafness can hear through electrical stimulation of the auditory nerve. The operation is delicate: the surgeon drills through the bone behind the ear, finds a path past the facial nerve and slides the array into a cochlea only a few millimetres across. This post traces how the operation began in Paris and Los Angeles, how robots started drilling and inserting electrodes, what MED-EL's new fully implanted device means, and where ABB robots fit around the operating room.

A MED-EL cochlear implant set: the implant with its electrode lead, the coil and processor worn on the ear, and a remote control. Photo: Thomas Haslwanter / Wikimedia Commons (CC BY-SA 4.0)

How surgeons first wired the inner ear

The first device came from Paris in 1957, when André Djourno and Charles Eyriès implanted a single channel electrode and showed that stimulating the auditory nerve could give a sense of sound. In Los Angeles, the otologist William House developed his own cochlear implant in 1961, and in 1964 Blair Simmons and Robert White implanted a single channel electrode at Stanford. Each of these early electrodes went in by hand, and the surgeon judged depth and resistance by feel.

William F. House of the House Clinic in Los Angeles, January 1968. Photo: House Ear Institute via Wikimedia Commons (CC BY-SA 3.0)

Multichannel implants changed what patients could hear. In December 1977 Ingeborg and Erwin Hochmair in Vienna implanted their device in a patient, and in August 1978 Graeme Clark implanted his multichannel device in Australia. In 1985 the US Food and Drug Administration approved Clark's Nucleus implant, the first multichannel implant to get that approval. About 188,000 people had implants by 2010, and the Ear Foundation estimated about 600,000 recipients worldwide by 2016.

Four generations of Advanced Bionics behind the ear cochlear implant processors. Photo: MikeCore9918 / Wikimedia Commons (CC BY-SA 4.0)

For most of that time the operation itself stayed manual. The most common route is a mastoidectomy with a facial recess approach: the surgeon removes part of the mastoid bone behind the ear, opens a small window between the facial nerve and other structures, and then pushes the array into the cochlea by hand. Every step depends on a steady hand and long training. Too much force or speed during insertion can damage the delicate structures inside the cochlea and the hearing a patient still has, which is why surgeons began looking at machines.

A surgeon wearing loupes during a tympanoplasty mastoidectomy aboard the hospital ship USNS Mercy, January 2024. Photo: Gavin Arnoldhendershot, U.S. Navy via Wikimedia Commons (public domain)

Robotic drilling, slow insertion and a fully implanted device

The first robotic step was drilling. A team at Bern's Inselspital and the ARTORG Center published its robotic cochlear implantation system in Science Robotics in March 2017. Planning software works out a path from CT images, and a robot drills a tunnel about 2.5 millimetres wide from behind the ear straight to the cochlea. The system was later sold as HEARO and received a European CE mark in 2020 for adult patients. In one Belgian series the surgeon completed the HEARO procedure in 22 of 25 patients.

Doctors and staff at the first cochlear implant surgery in Sri Lanka, Apollo Hospital, Colombo, 2004. Photo: Colelomas / Wikimedia Commons (CC BY-SA 4.0)

Other robots focus on the insertion itself. RobOtol, from the French company Collin, holds the electrode array while the surgeon steers it with a SpaceMouse, at speeds from 10 millimetres per second down to fractions of a millimetre per second; it has been used in France and China since 2019, and Prague's Motol hospital first used it in April 2022. In the United States, iotaMotion's thumb sized, bone mounted iotaSOFT received FDA De Novo authorisation in 2021 and, in January 2026, clearance for children aged four and up.

A cochlear implant with its electrode array shown beside an ear model at the Kulturama museum in Zurich. Photo: Tiia Monto / Wikimedia Commons (CC BY-SA 3.0)

This autumn's big cochlear implant story came from the device side. On 29 September 2026 MED-EL launched TICI UNICO, which IEEE Spectrum calls the first commercially available fully implanted cochlear implant: even the microphone sits about 6 millimetres under the scalp. It has European approval, a 30 patient trial reported hearing comparable to MED-EL's standard implants, and the first four commercial operations took place that morning. "For the first time, invisible hearing with a cochlear implant is possible," said CEO Ingeborg Hochmair, who shared the 2026 Honda Prize with Graeme Clark this September.

Ingeborg Hochmair, co founder and CEO of MED-EL, in 2013. Photo: Edith Mitschnigg / Wikimedia Commons (CC BY-SA 3.0)

Where robotic ear surgery goes next

Over the next years, robotic help in cochlear implant surgery will probably spread from a few research centres to more hospitals, as drilling robots and insertion aids gather clinical data and approvals. Researchers are already using AI to predict from a CT scan how much bone a surgeon will remove, which could feed robot planning. In a drilling robot, that kind of prediction would set the path before the first cut, and the surgeon would check it against the patient's own scan. Fully implanted devices like TICI UNICO add more parts to place under the skin, so precise, repeatable placement matters more. At home, patients care about the outcome: more of their natural hearing kept and fewer visible parts.

Engineers beside the single arm YuMi cell at GE Healthcare's prototype line in Helsinki. Photo: ABB

No ABB robot is used in cochlear implant surgery today, and ABB's arms are industrial machines without surgical certification. They could fit in the factories and labs behind the operation, which is a possibility rather than a reported project. The single arm YuMi IRB 14050 already works on a GE Healthcare prototype line in Helsinki, and arms like it could assemble or test small implant parts, as we describe in our post on hearing aid manufacturing. For the wider history of medical robots, see our post on the surgical robot.

A single arm YuMi IRB 14050 in its cell on GE Healthcare's prototype line in Helsinki. Photo: ABB

Cost, safety and skills will set the pace. Surgical robots add capital cost and operating time, and hospitals need evidence that patients hear better before they buy one. Any machine near the facial nerve must meet strict medical device rules, far beyond what an industrial cobot such as GoFa is certified for. Surgeons and engineers also need new training to plan paths, check images and take over when something looks wrong. Smaller hospitals that implant only a few patients a year will find that training hard to justify, so the first robots are likely to stay in large ear centres for some time.

A GoFa cobot at ABB's healthcare research hub. Photo: ABB

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