Introduction: Cochlear implantation, traditionally focused on hearing restoration in deaf patients, has expanded to include those with profound hearing loss but residual hearing. Emphasis is now placed on atraumatic insertion techniques to preserve hearing remnants and reduce postoperative vestibular symptoms. Damage during insertion due to crossing of the electrode array into the scala media or the scala vestibuli can disturb cochlear homeostasis, leading to reduced function and fibrotic remodeling.

Methods: The robotic assistance system, RobOtol®, used in our study, addresses challenges associated with manual insertion, allowing precise, standardized insertion at a controlled speed of 0.1 mm per second. Our prospective study aims to examine the usage of RobOtol® in 100 patients, evaluating insertion quality via postoperative CT scans, hearing preservation, tinnitus, vertigo, quality of life, taste disturbances, cochlear implant performance, meaning surgeons" handling and operation time.

Results: Initial clinical use suggests a promising benefit, making RobOtol® standard in our everday parctise, excluding cases with inner ear malformations. This system can even be applied in children, but they are not included in our analysis due to ethical concerns.

Discussion: While our experience is positive, further long-term prospective studies with larger cohorts are essential for evaluating the potential benefits of robot-assisted cochlear implantation on postoperative hearing.

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