Surgical stabilizer system

Abstract

Presented herein are techniques directed to stabilizing an implantable component and / or insertion system component (e.g., actuator) to facilitate implantation of the implantable component into a recipient. A stabilizer system is used to counteract an unintentional movement to stabilize the implantable component and / or the insertion system component relative to one or more insertion targets.

Description

Atty. Docket No. 3065.0873i Client Ref. No. CID03895WOPC1SURGICAL STABILIZER SYSTEM BACKGROUNDTechnical Field[oooi] The present disclosure relates generally to a surgical stabilizer system.Related Art

[0002] Medical devices are devices that are intended to be used for medical purposes. They can vary in both their intended use and indications for use. Examples range from simple, low-risk medical supplies to complex, potentially high-risk devices that are implanted and / or sustain life, such as deep brain stimulators and brain-computer interfaces. Other categories of medical device include diagnostic equipment.

[0003] Hearing devices act on an actual or potential auditory perception of an individual, including to improve perception of sound signals, to reduce perception of sound signals, etc. In particular, a hearing device can deliver sound signals to a user in any form, including in the form of acoustical stimulation, mechanical stimulation, electrical stimulation, etc., and / or can operate to suppress all or some sound signals. As such, a hearing device can be a device for use by a hearing-impaired person (e.g., hearing aids, middle ear auditory prostheses, bone conduction devices, direct acoustic stimulators, electro-acoustic hearing prostheses, auditory brainstem stimulators, bimodal hearing prostheses, bilateral hearing prostheses, dedicated tinnitus therapy devices, tinnitus therapy devices, etc.) or a device for use by a person with normal hearing (e.g., a consumer device that provides audio streaming, a consumer headphone, an earphone, etc.), a hearing protection device (e.g., a noise cancellation headset, a loudness reduction apparatus, etc.), etc.SUMMARY

[0004] In one aspect, a system is provided. The system comprises: a base; an actuator configured to couple to the stimulating assembly and to drive movement of the stimulating assembly into the recipient; and a stabilizer system coupling the actuator to the base, wherein the stabilizer system is configured to stabilize the actuator relative to one or more insertion targets.

[0005] In another aspect, a method is provided. The method comprises: determining a target position of an actuator configured to impart linear motion to a stimulating assembly during insertion of the stimulating assembly into a recipient; detecting movement of the actuator fromAtty. Docket No. 3065.0873i Client Ref. No. CID03895WOPC1the target position; and activating a stabilizer system coupled to the actuator to move the actuator toward the target position in response to detecting the movement of the actuator from the target position.

[0006] In yet another aspect, a system is provided. The system comprises: an implantable component; an actuator coupled to the implantable component and configured to drive movement of the implantable component for implantation in a recipient; a stabilizer system coupled to the actuator, wherein the stabilizer system is configured to stabilize the actuator relative to unintentional movement; and a processor communicatively coupled to the stabilizer system and configured to activate the stabilizer system to counteract application of at least one unintentional movement urging the actuator away from a target position.

[0007] In another aspect, a method is provided. The method comprises: determining one or more insertion targets for use during implantation of an implantable component into a recipient, wherein the implantable component is mechanically coupled to an insertion system comprising a stabilizer system and an actuator to move the implantable component; and while implanting the implantable component into the recipient, maintaining, via the stabilizer system, a relative positional relationship between at least one of the implantable component or the actuator and the one or more insertion targets.BRIEF DESCRIPTION OF THE DRAWINGS

[0008] Embodiments of the present disclosure are described herein in conjunction with the accompanying drawings, in which:

[0009] FIG. l is a schematic diagram illustrating a cochlear implant system with which aspects of the techniques presented herein can be implemented;[ooio] FIG. 2A is a cross-sectional view of a cochlea that has been partially cut-away to display canals and to illustrate a position of a stimulating assembly in the cochlea;[ooii] FIG. 2B is a simplified schematic view of the cochlea of FIG. 2A;

[0012] FIG. 3 is a perspective view of a surgical procedure with which aspects of the techniques presented herein can be implemented;

[0013] FIG. 4 is a schematic diagram of a stabilizer system, in accordance with certain embodiments presented herein;

[0014] FIG. 5 is a schematic diagram of another stabilizer system, in accordance with certain embodiments presented herein;Atty. Docket No. 3065.0873i Client Ref. No. CID03895WOPC1

[0015] FIG. 6 is a side view of an actuator that can be used with a stabilizer system, in accordance with certain embodiments presented herein;

[0016] FIG. 7 is a perspective front view of another actuator that can be used with a stabilizer system, in accordance with certain embodiments presented herein;

[0017] FIGs. 8, 9, 10, and 11 are flowcharts of methods, in accordance with certain embodiments presented herein;

[0018] FIG. 12 is a schematic diagram illustrating a vestibular stimulator system with which aspects of the techniques presented herein can be implemented;

[0019] FIG. 13 is a schematic diagram illustrating a retinal prosthesis system with which aspects of the techniques presented herein can be implemented;

[0020] FIG. 14 is a schematic diagram illustrating a tinnitus therapy device with which aspects of the techniques presented herein can be implemented;

[0021] FIG. 15 is a perspective view of an upper airway stimulation device with which aspects of the techniques presented herein can be implemented; and

[0022] FIG. 16 is a schematic diagram illustrating a computing device with which aspects of the techniques presented herein can be implemented.DETAILED DESCRIPTION

[0023] Presented herein are techniques for enhanced stabilization during a surgical procedure to insert an implantable component into a recipient. As an example, the techniques presented herein can be used to maintain a relative positional relationship (spatial arrangement) between the implantable component and one or more insertion targets and / or maintain a relative positional relationship between a component of an insertion system and one or more insertion targets. In one example, a target position of an implantable component or insertion system component is determined, and a stabilizer system is activated to place the implantable component or insertion system component at the target position, thereby resisting, compensating for, counteracting, discouraging, and / or preventing movement of the actuator from the target position.

[0024] More specifically, as described further below, an implantable component, such as a stimulation assembly, can be inserted into a recipient. During such a surgical procedure, the implantable component can be subject to various unintentional movements. As used herein, “unintentional movement / motion” of an implantable component includes any movement thatAtty. Docket No. 3065.0873i Client Ref. No. CID03895WOPC1is unwanted / undesired during insertion of the implantable component into a recipient. Unintentional movement can result from unintentional forces and can include jitters, vibrations, oscillations, resulting from, for example, a human (e.g., surgeon) during the insertion process, which can undesirably affect the surgical procedure by causing the component to move in an unpredictable / unintended manner and / or transfer unwanted forces to the recipient. Unintentional movement can additionally or alternatively result from passive forces (e.g., gravity).

[0025] Unintentional movements are contrasted with “intentional movements,” which are purposely applied to implant the implantable component into the recipient. For example, intentional movements advance an implantable component into a recipient, re-position an implantable component, etc. In certain examples, intentional movements can result from driving / advancing (e.g., moving) the implantable component into the recipient.

[0026] Embodiments of the present disclosure are directed to a stabilizer system that stabilizes an implantable component during a surgical procedure to remediate the effects of unintentional movements on the implantable component during the surgical procedure (e.g., substantially isolate the implantable component from unintentional movements, make automated corrections in response to unintentional movements, etc.). For example, in accordance with certain embodiments presented herein, a stabilizer system is configured to detect unintentional movements and then operate (e.g., via use of one or more motors) to counteract detected unintentional movements. The stabilizer system can operate with an actuator to drive the component toward a target position and / or can operate to maintain the maintain a relative positional relationship (spatial arrangement) between the implantable component and an insertion target and / or maintain a relative positional relationship between a component of an insertion system and an insertion target. In this manner, the stabilizer system can improve performance of the surgical procedure.

[0027] There are a number of different types of surgical procedures in / with which embodiments of the present disclosure can be implemented. Merely for ease of description, the techniques presented herein are primarily described with reference to implantation of a specific implantable component, namely a stimulating assembly associated with a cochlear implant system. However, it is to be appreciated that the techniques presented herein can also be used for implanting other types of implantable components, such as stimulating assemblies associated with other types of implantable medical devices. For example, the techniques presented herein can be implemented for implanting components of sensory protheses,Atty. Docket No. 3065.0873i Client Ref. No. CID03895WOPC1including hearing aids and cochlear implants, and various medical devices, such as pacemakers, drug delivery systems, implantable defibrillators, functional electrical stimulation devices, sleep disorder devices (e.g., sleep apnea devices), seizure devices (e.g., devices for monitoring and / or treating epileptic events), balance or movement disorder devices (e.g., vestibular stimulation devices), tinnitus management devices, visual implants (e.g., bionic eyes), and other neuromodulation devices (e.g., brain-computer interfaces.

[0028] FIG. 1 is perspective view of an exemplary cochlear implant 100 that can be implanted in a recipient 103 using techniques in accordance with embodiments presented herein. The cochlear implant 100 includes an external component 102 and an internal / implantable component 104. The external component 102 is directly or indirectly attached to the body of the recipient 103 and typically comprises an external coil 106 and, generally, a magnet (not shown in FIG. 1) fixed relative to the external coil 106. The external component 102 also comprises one or more sound input elements 108 (e.g., microphones, telecoils, etc.) for detecting sound and a sound processing unit 112 for processing sound. The sound processing unit 112 can include, for example, a power source (not shown in FIG. 1) and a sound processor (also not shown in FIG. 1). The sound processor is configured to process electrical signals generated by a sound input element 108 that is positioned, in the depicted embodiment, by auricle 110 of the recipient 103. The sound processor provides the processed signals to the external coil 106 via a cable (not shown in FIG. 1).

[0029] The implantable component 104 comprises an implant body 114, a lead region 116, and an elongate intra-cochlear stimulating assembly 118, all configured to be implanted under the skin / tissue (tissue) of the recipient 103. The implant body 114 comprises a stimulator unit 120, an internal / implantable coil 122, and an internal receiver / transceiver unit 124, sometimes referred to herein as a transceiver unit 124. The transceiver unit 124 is connected to the implantable coil 122 and, generally, a magnet (not shown) fixed relative to the implantable coil 122.

[0030] The magnets in the external component 102 and implantable component 104 facilitate the operational alignment of the external coil 106 with the implantable coil 122. The operational alignment of the coils 106, 122 enables the implantable coil 122 to transmit / receive power and data to / from the external coil 106. More specifically, in certain examples, the external coil 106 transmits electrical signals (e.g., power and stimulation data) to the implantable coil 122 via a radio frequency (RF) link. The implantable coil 122 is typically a wire antenna coil comprised of multiple turns of electrically insulated single-strand or multi-Atty. Docket No. 3065.0873i Client Ref. No. CID03895WOPC1strand platinum or gold wire. The electrical insulation of the implantable coil 122 is provided by a flexible molding (e.g., silicone molding). In use, the transceiver unit 124 can be positioned in a recess of the temporal bone of the recipient 103. Various other types of energy transfer, such as infrared (IR), electromagnetic, capacitive, and inductive transfer, can be used to transfer the power and / or data from an external device to the cochlear implant 100, and FIG. 1 illustrates only one example arrangement.

[0031] The stimulating assembly 118 is configured to be at least partially implanted in the cochlea 130 and includes a plurality of longitudinally spaced intra-cochlear contacts 128. The intra-cochlear contacts 128 can comprise electrical contacts and / or optical contacts and collectively form a contact array 126 for delivery of electrical stimulation signals (current) to the cochlea 130. The stimulating assembly 118 extends through an opening (e.g., a cochleostomy 132, a round window 134, etc.) in the cochlea 130 to position the contact array 126 within the cochlea 130, and the stimulating assembly 118 has a proximal end connected to the stimulator unit 120 via the lead region 116 that extends through a mastoid bone 119. The lead region 116 couples the stimulating assembly 118 to the implant body 114 and, more particularly, the stimulator unit 120.

[0032] An intra-cochlear stimulating assembly, such as the stimulating assembly 118, can be a perimodiolar stimulating assembly or a non-perimodiolar stimulating assembly. A perimodiolar stimulating assembly is a stimulating assembly that is configured to adopt a curved configuration during and / or after implantation into the recipient's cochlea so as to have at least the distal section positioned close to the wall of the recipient's modiolus (i.e., close to the modiolar wall). One type of non-perimodiolar stimulating assembly is a lateral stimulating assembly that is configured to be implanted so as to be positioned along the lateral wall (i.e., the wall that is opposite the modiolar wall) of the recipient’s scala tympani. Another type of non-perimodiolar stimulating assembly is a mid-scala stimulating assembly, which assumes a mid-scala position during or following implantation (i.e., positioned approximately midway between the modiolar wall and the lateral wall).

[0033] In general, the sound processor in the sound processing unit 112 is configured to execute sound processing and coding to convert a detected sound into a coded signal corresponding to electrical signals for delivery to the recipient 103. The coded signal generated by the sound processor is then sent to the stimulator unit 120 via the RF link between the external coil 106 and the implantable coil 122. The stimulator unit 120 includes one or more circuits that use the coded signals received via the transceiver unit 124 so as to outputAtty. Docket No. 3065.0873i Client Ref. No. CID03895WOPC1stimulation (stimulation current) via one or more stimulation channels that terminate in the intra-cochlear contacts 128. Therefore, the stimulation is delivered to the recipient 103 via the intra-cochlear contacts 128. In this way, the cochlear implant 100 stimulates the recipient's auditory nerve cells, bypassing absent or defective hair cells that normally transduce acoustic vibrations into neural activity.

[0034] FIG. 2A is a cross-sectional view of the cochlea 130 with the stimulating assembly 118 partially implanted therein. The cochlea 130 is a conical spiral structure that comprises three parallel fluid-filled canals or ducts, collectively and generally referred to herein as canals 236. The canals 236 comprise the tympanic canal 237, also referred to as the scala tympani 237, the vestibular canal 238, also referred to as the scala vestibuli 238, and the median canal 239, also referred to as the scala media 239. The cochlea 130 includes the modiolus 240, which is a conical shaped central region around which the canals 236 spiral. The modiolus 240 includes spongy bone in which cochlea nerve cells, sometimes referred to herein as the spiral ganglion cells, are situated. The canals 236 generally turn 2.5 times around the modiolus 240.

[0035] To insert the stimulating assembly 118 into the cochlea 130, an opening (facial recess) is created through the recipient's mastoid bone 119 (FIG. 1) to access the recipient's middle ear cavity 141 (FIG. 1). An opening is then formed from the middle ear into the cochlea 130 through, for example, the round window, oval window, the promontory, etc. of the cochlea 130. The stimulating assembly 118 is then gently advanced (e.g., pushed) forward into the cochlea 130 until the stimulating assembly 118 achieves a final implanted position. The stimulating assembly 118 follows the helical shape of the cochlea 130. That is, the stimulating assembly 118 spirals around the modiolus 240.

[0036] In normal hearing, sound entering the auricle 110 (FIG. 1) causes pressure changes in the cochlea 130. The pressure changes travel through the fluid-filled tympanic and vestibular canals (e.g., 237, 238). The organ of Corti 242, which is situated on the basilar membrane 244 in the scala media 239, contains rows of hair cells (not shown), which protrude from its surface. Located above the hair cells is the tectoral membrane 245, which moves in response to pressure variations in the fluid-filled tympanic and vestibular canals. Small relative movements of the layers of the tectoral membrane 245 are sufficient to cause the hair cells to move, thereby causing the creation of a voltage pulse or action potential that travels along the associated nerve fibers connecting the hair cells with the auditory nerve 246. The auditory nerve 246 relays the impulses to the auditory areas of the brain (not shown) for processing.Atty. Docket No. 3065.0873i Client Ref. No. CID03895WOPC1

[0037] Typically, in cochlear implant recipient 103, some portion of the cochlea 130 (e.g., the hair cells) is damaged such that the cochlea 130 cannot transduce pressure changes into nerve impulses for relay to the brain. Consequently, the intra-cochlear contacts 128 of the stimulating assembly 118 are used to directly stimulate the cells to create nerve impulses resulting in perception of a received sound. Due to the illustrative view, only a subset of the intra-cochlear contacts 128 is visible in FIG. 2A. As noted above, the intra-cochlear contacts 128 deliver stimulation to the cochlea 130 to evoke a hearing percept. The effectiveness of the stimulation depends, at least in part, on the place along the basilar membrane 244 where the stimulation is delivered. That is, the cochlea 130 has characteristically been referred to as being “tonotopically mapped” in that regions of the cochlea 130 toward the basal end are more responsive to high frequency signals, while regions of cochlea 130 toward the apical end are more responsive to low frequency signals. These tonotopical properties of the cochlea 130 are exploited in a cochlear implant by delivering stimulation within a predetermined frequency range to a region of the cochlea 130 that is most sensitive to that particular frequency range. However, this stimulation relies on the particular intra-cochlear contacts 128 having a final implanted positioned adjacent to a corresponding tonotopic region of the cochlea 130 (i.e., a region of the cochlea 130 that is sensitive to the frequency of sound represented by the intra-cochlear contact 128).

[0038] FIG. 2B is a simplified top view of cochlea 130 illustrating stimulating assembly 118 partially implanted therein. In the specific embodiments illustrated herein, the stimulating assembly 118 comprises twenty -two (22) intra-cochlear contacts 128(1) through 128(22), which can deliver stimulation to the cochlea 130. The intra-cochlear contact 128(1) is the most proximal / basal contact (i.e., the contact configured to be implanted closest to the basal end of the cochlea 130), while the intra-cochlear contact 128(22) is the most distal / apical contact (i.e., the contact configured to be implanted closest to the cochlea apex 243). A reference contact (not shown in FIGS. 2A and 2B) can also be provided. The reference contact is positioned outside of the recipient's cochlea 130 and, therefore, is sometimes referred to as an extra-cochlear electrode (ECE).

[0039] To achieve a correct final implanted position, a distal end / tip 250 of the stimulating assembly 118 should be placed at a correct angular position, sometimes referred to herein as a correct angular insertion depth. As used herein, the angular position or angular insertion depth of the stimulating assembly 118 refers to the angular rotation of the distal end 250 from a cochlea opening 251 (e.g., round window, cochleostomy, etc.) through which the stimulatingAtty. Docket No. 3065.0873i Client Ref. No. CID03895WOPC1assembly 118 enters the cochlea 130. As such, the angular position / angular insertion depth can be expressed in terms of how many angular degrees (°) the distal end 250 has traveled within the cochlea 130 with respect to the cochlea opening 251. For example, an angular insertion depth of one hundred and eighty (180) degrees indicates that the distal end 250 has traveled around half (’A) of a first turn 276 of the cochlea 130. An angular insertion depth of three hundred and sixty (360) degrees indicates that the distal end 250 has traveled completely around the first turn 276. Angular insertion depth, if achieved accurately, is a constant for all recipients to enable correct frequency alignment (i.e., positioning of the intra-cochlear contacts 128(1)-128(22) adjacent to a corresponding tonotopic region of the cochlea 130).

[0040] The cochlea 130 shown in FIG. 2B is defined so as to include a central axis 252 extending generally through the geometric center of the cochlea 130 (e.g., through the modiolus 240). The cochlea 130 is further defined to include a plurality of different angular points with respect to the central axis 252. In particular, a zero (0) degree angular point (0° point) 254 is a point within the scala tympani 237 that is located at or adjacent to the cochlea opening 251 through which the stimulating assembly 118 is inserted. A one hundred and eighty (180) degree angular point (180° point) 256 is a point within the scala tympani 237 that is diametrically opposite from the 0° point 254 (i.e., the 180° point 256 is located on the opposite side of the modiolus 240 from the 0° point 254). The 0° point 254 and 180° point 256 both lie within a reference plane 257 that passes through the central axis 252. As noted above, the scala tympani 237 spirals around the modiolus 240. Accordingly, the 180° point 256 is further “up” the cochlea spiral (i.e., at a different level within the reference plane 257) than the 0° point 254. FIG. 2B illustrates the distal end 250 of the stimulating assembly 118 positioned within the cochlea 130. The depth at which the distal end 250 of stimulating assembly 118 can be positioned within the cochlea 130 can vary between different cochlea 130.

[0041] As discussed herein, a surgical procedure is performed to implant the stimulating assembly 118 within the cochlea 130. Specifically, the stimulating assembly 118 is inserted into the cochlea opening 251 to curve along the shape of the cochlea 130 (e.g., around the first turn 276). Therefore, during the surgical procedure, it is desirable for the stimulating assembly 118 to be stably positioned and advanced, such as with respect to the cochlea opening 251, to enable the stimulating assembly 118 to be inserted as desired into the cochlea 130 for positioning the intra-cochlear contacts 128. Indeed, even small, unwanted movements of the stimulating assembly 118 can bring the intra-cochlear contacts 128 out of alignment with a target region of the cochlea 130 and therefore negatively affect operation of the stimulatingAtty. Docket No. 3065.0873i Client Ref. No. CID03895WOPC1assembly 118 to stimulate the cochlea 130. Unintentional movement of the stimulating assembly 118 can additionally or alternatively impart unwanted forces onto the cochlea 130 and potentially deteriorate functionality and / or structural integrity of the cochlea 130, further negatively affecting operation of the stimulating assembly 118 (e.g., by reducing residual hearing of the recipient).

[0042] FIG. 3 illustrates a surgical setting in which a surgeon 301 manually performs at least a portion of a surgical procedure to implant the stimulating assembly 118 (not shown in FIG.3) in cochlea 130 (also not shown in FIG. 3) of the recipient 103. As shown, the surgeon 301 holds a handle 305 during the surgical procedure and guides the stimulating assembly 118 into the cochlea 130 by positioning the handle 305, such as with respect to an opening surgically formed into the recipient 103.

[0043] In the example of FIG. 3, movement of the handle 305 can cause movement of the stimulating assembly 118. For example, the surgeon can manipulate the handle 305 to insert the stimulating assembly 118 into the cochlea 130 (e.g., the surgeon purposely moves handle 135 in a direction to insert the stimulating assembly 118 into the cochlea). This purposeful movement is an intentional movement applied to the stimulating assembly 118. However, the handle 305, and thus the stimulating assembly 118, are also potentially subject to unintentional movements (e.g., resulting from shaking of the surgeon’s hand). Therefore, it is desirable to limit unwanted movement of the handle 305. Presented herein is a stabilizer system (not shown in FIG. 3) that can stabilize the handle 305, such as by resisting and / or compensating for unintentional movements caused by the surgeon 301, and accordingly facilitate placement of the stimulating assembly 118 at the desirable position in the cochlea 130. As an example, the stabilizer system can operate to retain a relative positional relationship (spatial arrangement) between the stimulating assembly 118 and a target, potentially without usage of an external support or other reinforcement that can increase a cost and / or complexity associated with the surgical procedure.

[0044] Although FIG. 3 illustrates the surgical procedure being manually performed by the surgeon 301 holding the handle 305, in some embodiments, the techniques discussed herein can be incorporated in a surgical procedure in which the stimulating assembly 118 is implanted using other techniques. As an example, in certain embodiments, the stimulating assembly 118 is being supported by a relatively fixed mount or other anchor intended to hold the stimulating assembly 118. As another example, the stimulating assembly 118 is automatically being implanted by a robot. However, the stimulating assembly 118 can still be subject to unwantedAtty. Docket No. 3065.0873i Client Ref. No. CID03895WOPC1movement, in such examples. For instance, imprecisely generated movements, misaligned components, propagated motion of the stimulating assembly 118, and / or gravitational forces can cause the mount and / or the robot supporting the stimulating assembly 118 to vibrate.

[0045] FIG. 4 is a schematic diagram of an embodiment of a system or assembly 407 (e.g., an insertion system or an insertion assembly) that can be used for a surgical procedure, such as to insert a stimulating assembly in a cochlea of a recipient. The system 407 includes a base 409 used to support a portion of the system 407. In some embodiments, the base 409 (e.g., a handle) is handheld and can be grasped by a user (e.g., a surgeon) for manual positioning of the system 407. In additional or alternative embodiments, the base 409 (e.g., a mount) is configured to couple to a surface, such as of a relatively fixed support and / or of a device (e.g., a robot) that automatically positions the system 407, such as to automatically perform the surgical procedure. The system 407 also includes an actuator 411 (e.g., an actuator base) configured to couple to a stimulating assembly (e.g., the stimulating assembly 118) and to drive movement of the stimulating assembly (e.g., to insert the stimulating assembly into the recipient). The system 407 further includes a stabilizer system 413 that couples the base 409 and the actuator 411 to one another and that is configured to stabilize the actuator 411, such as relative to an insertion target (e.g., a surgically formed opening of a recipient, such as of a cochlea).

[0046] To this end, during insertion of the stimulating assembly in a cochlea of a recipient, the stabilizer system 413 is configured to maintain a relative positional relationship (spatial arrangement) between the stimulating assembly and one or more “insertion targets” and / or maintain a relative positional relationship between one or more components of the insertion system (e.g., an actuator) and the one or more insertion targets. As used herein, an “insertion target” is a predetermined or fixed reference point in the surgical environment. The insertion targets (reference points) can be in the surgical environment, in / on the recipient, etc.

[0047] As described further below, the techniques presented herein can be implemented with a number of different insertion targets. In some examples, the insertion targets comprise a plurality (e.g., at least three (3)) reference objects in the surgical environment. The reference objects can be stationary objects or moving objects, if the movement is predictable. The reference objects can be user indicated (e.g., input into the stabilizer system 413), or user applied (e.g., stickers or other indicators applied to objects in the surgical environment that can be automatically identified by the stabilizer system 413), could be selected automatically by the system (e.g., using machine learning to recognize one or more stationary objects), etc.Atty. Docket No. 3065.0873i Client Ref. No. CID03895WOPC1

[0048] As noted, in certain embodiments, the one or more insertion targets could be in / on the recipient (e.g., the user could place an indicator at the desired location in the recipient, the stabilizer system 413 could automatically recognize a cochleostomy, etc.). In these examples, again the one or more insertion targets (e.g., reference points) in / on the recipient do not necessarily have to be static or stationary. For example, a system presented herein can track movement of the recipient (or part thereof). In one illustrative arrangement, the one or more insertion targets could be on the heart, then the system could track the motion of the heart as it was beating. This could be useful for heart operations, such as implantation of pacemakers, RF ablation, etc.

[0049] As described further below, stabilizer system 413 is configured to determine a “target position” for the stimulating assembly (or an insertion system component, such as an actuator) relative to the one or more insertion targets. The target position can be user indicated (e.g., input into the stabilizer system 413 or a position of stimulating assembly or insertion system component at a given time instance) or could be selected automatically by the stabilizer system 413. In any event, in accordance with embodiments presented herein, the stabilizer system 413 is configured to, during the surgical procedure, maintain the stimulating assembly or an insertion system component at the target position (e.g., maintain a relative positional relationship between the stimulating assembly or an insertion system component and the one or more insertion targets).

[0050] As used herein, the phrases “maintain the stimulating assembly or an insertion system component at the target position” or “maintain a relative positional relationship between the stimulating assembly or an insertion system component and the one or more insertion targets” do not necessarily require or imply that the stimulating assembly or an insertion system component maintain a fixed position. Instead, these phrases encompass intentional / purposeful movement of the stimulating assembly or an insertion system component during the course of a surgical procedure.

[0051] For example, in certain embodiments, the target position could indeed be a fixed position in space and the techniques presented herein can be implemented to maintain at least a portion of the stimulating assembly or the insertion system component at the fixed position. However, as described elsewhere herein, the stimulating assembly itself is advanced into the recipient. Therefore, in such a context, the phrases “maintain the stimulating assembly or an insertion system component at the target position” or “maintain a relative positional relationship between the stimulating assembly or an insertion system component and the oneAtty. Docket No. 3065.0873i Client Ref. No. CID03895WOPC1or more insertion targets” allow for this intentional / purposeful movement of the stimulating assembly and the positional relationship is maintained while the stimulating assembly is advanced into the recipient. Stated differently, the operations described herein to maintain a relative positional relationship between the stimulating assembly or an insertion system component and the one or more insertion targets can account for intentional / purposeful movement of the stimulating assembly or insertion system component during the course of a surgical procedure /

[0052] By way of example, and referring specifically to FIG. 4, the actuator 411 (coupled to a stimulating assembly, which has been omitted from FIG. 4 for ease of illustration) can be located at a target position. The stabilizer system 413 can detect unintentional movements (e.g., some unintentional movement of the base 409) that would move the actuator 411 away from the target position. In response to detection of the unintentional movement, the stabilizer system 413 can operate to resist and / or compensate for the detected movement of the base 409. The illustrated stabilizer system 413 includes rotary motors 417 in the form of gimbal motors. Respective segments 419 couple the rotary motors 417 to one another and to the base 409 and actuator 411, and each rotary motor 417 is configured to provide respective rotational movement to drive movement of the segments 419, thereby moving the actuator 411 relative to the base 409.

[0053] As an example, in response to detected movement of the base 409, at least one of the rotary motors 417 rotates to move the actuator 411 relative to the base 409 such that the actuator 411 is maintained at the target position (e.g., pointed at the insertion target). For instance, such movement of the actuator 411 relative to the base 409, as effectuated by the stabilizer system 413, prevents or discourages unintentional movement of the base 409 (in response to application of the unintentional movements) from urging the actuator 411 away from the target position.

[0054] The illustrated stabilizer system 413 of FIG. 4 includes a first motor 417A connected to the base 409 via a first segment 419A, a second motor 417B connected to the first motor 417A via a second segment 419B, and a third motor 417C connected to the second motor 417B via a third segment 419C and to the actuator 411 via a fourth segment 419D. The first motor 417A is configured to rotate about a first axis 421 (e.g., a vertical axis), the second motor 417B is configured to rotate about a second axis 423 (e.g., a lateral axis), and the third motor 417C is configured to rotate about a third axis 425 (e.g., a longitudinal axis). The axes 421, 423, 425 are oriented perpendicular to one another in the illustrated embodiment, but the axes 421, 423,Atty. Docket No. 3065.0873i Client Ref. No. CID03895WOPC1425 can extend transversely to one another in any suitable manner in additional or alternative embodiments. The segments 419 (e.g., the segments 419B, 419C interconnecting the rotary motors 417 to one another) can also extend in any suitable manner, such as in an arcuate or non-linear direction, to enable rotation of the rotary motors 417 to effectuate desirable movement of the actuator 411 relative to the base 409, such as around and / or along any of the axes 421, 423, 425.

[0055] During operation of the system 407 to stabilize the actuator 411, positional (e.g., rotational) feedback of the rotary motors 417 is used to detect movement of the base 409 and corresponding operation to resist and / or compensate for such movement. For example, movement of the base 409 propagates to drive movement (e.g., rotation) of at least one of the rotary motors 417. The system 407 then determines corresponding movement to counteract such movement of the motor(s) 417. For example, a motor 417 can be driven in a direction opposite to that caused by unintentional movement of the base 409, and / or a motor 417 that is not moved by unintentional movement of the base 409 can be driven to rotate. By monitoring the position of the rotary motors 417 as feedback for stabilizing the actuator 411, the system 407 can react more readily and accurately in response to unintentional movements, such as in comparison to detecting force imparted onto the actuator 411. To this end, the system 407 includes one or more sensors 427 (e.g., an internal sensor, a movement sensor, an inertial measurement unit) that are configured to monitor the rotational position / movement of the rotary motors 417 for activating the stabilizer system 413.

[0056] Although the illustrated stabilizer system 413 includes three rotary motors 417, the stabilizer system 413 can include any other suitable quantity of rotary motors 417 (e.g., one motor 417, two rotary motors 417, more than three rotary motors 417) in additional or alternative embodiments. Moreover, at least one of the rotary motors 417 can be configured to translate rather than rotate. As an example, the stabilizer system 413 can have three motors configured to translate and no motors configured to rotate, or the stabilizer system 413 can have a mixture of motors configured to rotate and translate.

[0057] As above, in some embodiments, the target position of the actuator 411 is a set position with respect to one or more reference points (insertion targets) in a 3-D space. Such reference points can be user selected or automatically defined and can be positioned at any suitable location with respect to one another, with respect to the recipient of the cochlea implant, with respect to the system 407, and / or with respect to a surgeon. For example, the reference points can be positioned at a distance above a threshold from one another, from the recipient, fromAtty. Docket No. 3065.0873i Client Ref. No. CID03895WOPC1the system 407, and / or from the surgeon to cooperatively encompass a larger 3-D space in which the 3-D coordinate position of the actuator 411 can be determined. In some embodiments, the reference points are offset from one another along 3 planes defined by the axes 421, 423, 425 to enable the system 407 to determine the position of the actuator 411 more accurately (e.g., along each of the axes 421, 423, 425) with respect to the target position.

[0058] FIG. 5 is a schematic diagram of an embodiment of another system or assembly 507 that can be used for a surgical procedure, such as to insert a stimulating assembly in a cochlea of a recipient. The system 507 includes a base 509 (e.g., a base, a mount) used to support a position of the system 507. The system 507 also includes an actuator 511 (e.g., an actuator base) configured to couple to a stimulating assembly (e.g., the stimulating assembly 118) and to drive movement of the stimulating assembly. The system 507 further includes a stabilizer system 513 that couples the base 509 and the actuator 511 to one another and that is configured to stabilize the actuator 511.

[0059] The stabilizer system 513 includes multiple segments 519 that are oriented transverse to one another. For example, a first segment 519A extends along the first axis 421, a second segment 519B extends along the second axis 423, and a third segment 519C extends along the third axis 425. Additionally, the stabilizer system 513 includes motors 517 configured to move the actuator 511 relative to the base 509. In particular, a first motor 517A is configured to move the base 509 relative to the second segment 519B (e.g., along the first segment 519A), a second motor 517B is configured to move the third segment 519C relative to (e.g., along) the second segment 519B, and a third motor 517C is configured to move the actuator 511 relative to (e.g., along) the third segment 519C. As an example, each of the motors 517 is configured to drive linear movement to position the actuator 511 desirably, such as to selectively move the actuator 511 along any of the axes 421, 423, 425. However, in alternative embodiments, at least one of the motors 517 is configured to drive rotational movement. In further embodiments, the system 507 can include a different quantity of motors 517 (e.g., one motor 517, two motors 517, more than three motors 517).

[0060] The stabilizer system 513 is configured to activate to maintain the actuator 511, and therefore the stimulating assembly coupled to the actuator 511, at a target position. As an example, the system 507 is configured to determine a 3-dimensional (3-D) coordinate position of the actuator 511 and / or of the stimulating assembly relative to the target position. The system 507 is then configured to detect movement of the base 509 by determining a distance and / or a direction (e.g., a vector) between the actuator 511 and the target position. Based onAtty. Docket No. 3065.0873i Client Ref. No. CID03895WOPC1the distance and / or the direction, the system 507 is configured to actuate at least one of the motors 517 to drive movement of the actuator 511 toward the target position, thereby placing the actuator 511 at the target position.

[0061] As above, in some embodiments, the target position of the actuator 511 is a set position with respect to one or more reference points in a 3-D space. Such reference points can be user selected or automatically defined and can be positioned at any suitable location with respect to one another, with respect to the recipient of the cochlea implant, with respect to the system 507, and / or with respect to a surgeon. For example, the reference points can be positioned at a distance above a threshold from one another, from the recipient, from the system 507, and / or from the surgeon to cooperatively encompass a larger 3-D space in which the 3-D coordinate position of the actuator 511 can be determined. In some embodiments, the reference points are offset from one another along 3 planes defined by the axes 421, 423, 425 to enable the system 507 to determine the position of the actuator 511 more accurately (e.g., along each of the axes 421, 423, 425) with respect to the target position.

[0062] In some embodiments, the system 507 includes one or more sensors 527 (e.g., one or cameras or optical sensors, one or more distance sensors, one or more ultrasonic pulsing sensors, one or more magnetic sensors, etc.) configured to determine the 3-D coordinate position of the actuator 511. In various forms, the one or more sensors 527 could include cameras, inertial measurement units, electromagnetic navigation systems, and / or laser-based systems, each of which could be used to controlling a relative positional relationship (spatial arrangement) between an implantable component and insertion system component relative to one or more insertion targets.

[0063] By way of example, the sensor(s) 527 can determine a physical positioning of the actuator 511 based on imaging (e.g., the system includes one or more cameras that learn the position in space relative to the plurality of reference points, and three axes linear actuators are used to drive the base so as to keep it stationary relative to the programmed reference points).

[0064] As described elsewhere herein, in certain examples, the techniques presented herein could be used to move an implantable component and / or actuator configured to move the implantable component to a desired / target position (and stay there despite subsequent hand movement of a surgeon). Also as noted elsewhere herein, the target position could be indicated by the user, determined automatically (e.g., using artificial intelligence or another machine learning technique), etc. In one example, the surgeon can hold an actuator (attached to aAtty. Docket No. 3065.0873i Client Ref. No. CID03895WOPC1stabilizer system presented herein) somewhere near the target position and then the stabilizer system tracks to the target position. A subsequent useful action can then take place from this stable target position (e.g., controlled robotic insertion of a stimulating assembly into the cochlea).

[0065] FIG. 6 is a detailed view of an actuator 611 that can be used in accordance with an insertion system presented herein (e.g., system 407 or system 507) to insert a stimulating assembly in a recipient. The actuator 611 includes a support 631, which can include features (e.g., a hole, a latch, an extension) to secure the actuator 611 to a stabilizer system (e.g., the stabilizer system 413, the stabilizer system 513). An extension 633 (e.g., a tube, a channel) extends from the support 631 and defines a pathway 635 (e.g., a recess, a chamber) in which a slider 637 is positioned. The slider 637 is configured to couple to a stimulating assembly (e.g., a proximal end), and the slider 637 is configured to move within the pathway 635 and correspondingly adjust a position of the stimulating assembly. By way of example, the pathway 635 defined by the extension 633 is linear such that the slider 637 is primarily configured to translate and impart linear motion on the stimulating assembly to drive movement of the stimulating assembly. However, the pathway 635 can have any suitable profile (e.g., a bend) to enable the slider 637 to move in a suitable manner.

[0066] The actuator 611 is configured to move the slider 637 by applying an intentional force, such as a magnetic force, an electrical force, a physical force, and so forth, against the slider 637 to cause the slider 637 to move along the pathway 635 of the extension 633. In particular, movement of the slider 637 away from the support 631 and toward a distal end 639 of the extension 633 inserts the stimulating assembly further into the recipient, whereas movement of the slider 637 away from the distal end 639 and toward the support 631 retracts the stimulating assembly from the recipient. The actuator 611 can include a release mechanism (e.g., at the extension 633) to enable the stimulating assembly to be decoupled from the actuator 611, such as to remove the actuator 611 and the stabilizer system from the recipient without removing the stimulating assembly and complete implantation of the stimulating assembly in the recipient.

[0067] In some embodiments, the actuator 611 is manually activated. By way of example, the user can interact with a user interface (e.g., a component of the actuator 611, a dedicated user interface in communication with the actuator 611), such as a button, a switch, a dial, a knob, a touch screen, and the like, to move the slider 637 and therefore the stimulating assembly. In additional or alternative embodiments, the actuator 611 is automatically controlled to move theAtty. Docket No. 3065.0873i Client Ref. No. CID03895WOPC1slider 637. For instance, the slider 637 is moved based on sensor feedback, which can indicate a determined positioning of the stimulating assembly within the recipient.

[0068] FIG. 7 is a schematic view of an embodiment of another actuator 711 configured to couple to a stabilizer system for implanting a stimulating assembly in a recipient, in accordance with certain embodiments presented herein. In this example, the actuator 711 includes two spools 741 configured to hold / retain an elongate stimulating assembly 718 therebetween. As one of the spools 741 rotates, the stimulating assembly 718 is advanced into a recipient.

[0069] The actuator 711 can be manually and / or automatically activated. Thus, the actuator 711 can include a user interface, such as a button, a switch, a dial, a knob, a touch screen, and the like, with which a user can interact to actuate the spools 741 and therefore the stimulating assembly. The spools 741 can additionally or alternatively be rotated based on sensor feedback, such as a determined positioning of the stimulating assembly within the recipient.

[0070] Each of FIGs. 8, 9, 10, and 11 illustrates a method for providing stabilization benefits during a surgical procedure, such as to stabilize a stimulating assembly during insertion into a recipient, in accordance with embodiments presented. However, it should be noted that each method can be used to stabilize any suitable component. It should also be noted that any of the methods can be performed differently than depicted. For example, an additional operation can be performed, and / or any of the depicted operations can be performed differently, not performed, and / or performed in a different order. Moreover, the respective operations of each method can be performed in any suitable manner with respect to one another, such as simultaneously and / or sequentially with respect to one another.

[0071] FIG. 8 is a flowchart of a method 861 for operating a stabilizer system, such as the stabilizer system 413 and / or the stabilizer system 513. At block 863, the system determines a target position of an implantable component (e.g., stimulating assembly) and / or a target position of an actuator configured to move the implantable component, such as by imparting linear motion to the stimulating assembly. As noted above, the target position can be determined in a number of different manners. In certain embodiments, the target position is a particular position relative to the recipient and can indicate a position of the actuator and / or of the stimulating assembly relative to one or more insertion targets (e.g., an opening of a cochlea, reference objects in the surgical environment, etc.). In certain embodiments, the target position is determined based on a measurement related to the recipient, such as an electrical measurement (e.g., electromyography, electrocochleography).Atty. Docket No. 3065.0873i Client Ref. No. CID03895WOPC1

[0072] At block 865, movement of the implantable component and / or of the actuator from the target position is detected. Such movement can include movement resulting from application of an unintentional movement (e.g., resulting from shaking caused by a user, vibration caused by movement of a robot controlling the actuator, etc.). The movement can oscillate the implantable component and / or the actuator into and out of the target position (e.g., between two non-target positions adjacent to the target position). Movement of the implantable component and / or the actuator from the target position can be detected based on movement of a base (e.g., held by the user, mounted to the robot) connected to the actuator.

[0073] At block 867, a stabilizer system is activated to place the implantable component and / or the actuator at the target position (e.g., the stabilizer system operates to maintain a relative positional relationship between the implantable component and / or the actuator and the one or more insertion targets). That is, the stabilizer system prevents, limits, or discourages movement of the implantable component and / or the actuator away from the target position, such as by resisting or compensating for movement of the implantable component and / or the actuator from the target position. As an example, the stabilizer system maintains the implantable component and / or the actuator at the target position. As another example, the stabilizer system moves the implantable component and / or the actuator toward the target position. In either case, activation of the stabilizer system to place the implantable component and / or the actuator at the target position stabilizes the implantable component and / or the actuator relative to the one or more insertion targets.

[0074] In some embodiments, the method 861 is selectively performed, such as in response to an input. However, absent the input or in response to an additional input, operation of the method 861 can be suspended. While operation of the method 861 is suspended, the implantable component and / or the actuator can be freely moved without activating the stabilizer system. For example, the method 861 is suspended to enable the implantable component and / or the actuator to be intentionally moved away from the target position.

[0075] Furthermore, in certain implementations, the target position is dynamic and can change over time. As an example, the target position is a fixed position relative to the recipient such that movement of the recipient can cause the target position to move correspondingly. For this reason, the target position can be updated based on movement of the recipient, and the stabilizer system can be activated to place (e.g., move, maintain, retain) the implantable component and / or the actuator at the updated target position. As another example, the target position can change based on a position of the implantable component with respect to the recipient (e.g.,Atty. Docket No. 3065.0873i Client Ref. No. CID03895WOPC1with respect to a target path / position relative to the recipient), such as within the cochlea. Indeed, as the position of the implantable changes within the recipient (e.g., as a stimulating assembly is inserted into the recipient), the target position that enables the implantable component to be desirably inserted in the recipient (e.g., to bend and conform to a shape of the cochlea) can change. Therefore, the target position can be updated based on the change in position of the implantable component, and the stabilizer system can be activated to place the implantable component and / or the actuator at the updated target position.

[0076] FIG. 9 is a flowchart of a method 961 providing example embodiments of blocks 865 and 867 of FIG. 8 regarding detecting movement of an actuator from a target position and activating a stabilizer system to place the actuator at the target position, respectively. At block 965 of the method 961, movement of the actuator from the target position is determined based on unintentional movement of a motor of the stabilizer system coupled to the actuator. For instance, the stabilizer system includes motors interconnected with one another and connected to the actuator via respective segments. At block 967, the motor is activated to counteract the unintentional movement to place the actuator at the target position. For example, the motor is driven in a direction opposite that of the unintentional movement. In some embodiments, the motor is configured to rotate to counteract the unintentional movement. In additional or alternative embodiments, the motor is configured to translate to counteract the unintentional movement.

[0077] A gimbal technique can be utilized to determine unintentional movement of the motor and to counteract such unintentional movement. The gimbal technique includes using positional feedback of the motor to detect the unintentional movement of the motor, determine the resulting movement of the actuator from the target position caused by the unintentional movement of the motor, and determine the corresponding movement to counteract the unintentional movement and place the actuator at the target position. The gimbal technique can, for instance, keep the actuator pointed at the target position.

[0078] FIG. 10 is a flowchart of a method 1061 providing example embodiments of blocks 863, 865, and 867 of FIG. 8 regarding determining a position of an actuator, detecting movement of the actuator from a target position, and activating a stabilizer system to place the actuator at the target position, respectively. At block 1063 of the method 1061, a target position of the actuator is determined as a point in space (e.g., a 3-D space). For example, the target position of the actuator is represented by a set of coordinate points. At block 1065, movement of the actuator from the target position is determined based on movement of the actuator fromAtty. Docket No. 3065.0873i Client Ref. No. CID03895WOPC1the point in space, such as based on a change in the set of coordinate points. To this end, the position of the actuator in the space is continually monitored to determine an updated position of the actuator over time. Movement of the actuator from the point in space can be determined in response to a difference between the updated position and the target position exceeding a threshold. At block 1067, a motor of the stabilizer system is activated to move the actuator toward the target position, such as to reduce the difference between the position of the actuator and the target position below the threshold. In some embodiments, the difference between the position of the actuator and the target position includes a distance and a direction (e.g., a vector), and the motor is activated to move the actuator based on the direction to reduce the distance below a threshold. The motor can be rotated and / or translated to move the actuator toward the target position.

[0079] FIG. 11 is a flowchart of a method 1163 providing an example embodiment of FIG. 10 regarding determining a target position of an actuator as a point in space relative to a plurality of reference points (insertion targets). At block 1171 , a plurality of reference points (or obj ects) in space are determined / obtained. In some embodiments, the plurality of reference points are offset from one another along 3 planes in space such that the plurality of reference points are three-dimensionally offset. However, in some embodiments, the plurality of reference points are offset from one another along 2 planes and are two-dimensionally offset. The plurality of reference points can be user-defined or selected in certain embodiments, and / or the plurality of reference points can be automatically defined and selected. Moreover, the plurality of reference points can be offset from one another (and / or from the recipient, from the actuator) to cooperatively encompass a sufficiently large area / volume.

[0080] At block 1173, a set position relative to the plurality of insertion targets is determined. The set position can be established based on a position / posture of the recipient, such as with respect to an opening of a cochlea of the recipient. At block 1175, the set position is established as the target position of the actuator. Thus, the actuator is placed (e.g., moved, maintained, retained) relative to the plurality of insertion targets at the target position during operation of a stabilizer system. For example, the set position enables desirable operation of the actuator to insert the stimulating assembly in the recipient.

[0081] As previously described, the technology disclosed herein can be applied in a variety of different surgical procedures related to implantation of a variety of different devices. Example surgical procedures that can benefit from technology disclosed herein are described in more detail in FIGS. 12-15 for a vestibular stimulator system, a retinal prosthesis system, a tinnitusAtty. Docket No. 3065.0873i Client Ref. No. CID03895WOPC1therapy device, and an upper airway stimulation device. However, the techniques of the present disclosure can be applied to implant other devices, such as neurostimulators, cardiac pacemakers, cardiac defibrillators, seizure therapy stimulators, as well as other implantable medical devices. These different surgical procedures can benefit from the technology described herein.

[0082] FIG. 12 illustrates an example vestibular stimulator system 1002 (e.g., a balance or movement disorder system). As shown, the vestibular stimulator system 1002 comprises an implantable component (vestibular stimulator) 1012 and an external device / component 1004 (e.g., external processing device, battery charger, remote control, etc.). The external device 1004 comprises a transceiver unit 1060. As such, the external device 1004 is configured to transfer data (and potentially power) to the vestibular stimulator 1012.

[0083] The vestibular stimulator 1012 comprises an implant body (main module) 1034, a lead region 1036, and a stimulating assembly 1016, all configured to be implanted under the skin / tissue (tissue) 1015 of the recipient. The implant body 1034 generally comprises a hermetically-sealed housing 1038 in which RF interface circuitry, one or more rechargeable batteries, one or more processors, and a stimulator unit are disposed. The implant body 1034 also includes an intemal / implantable coil 1014 that is generally external to the housing 1038, but which is connected to the transceiver via a hermetic feedthrough (not shown).

[0084] The stimulating assembly 1016 comprises a plurality of electrodes 1044(l)-(3) disposed in a carrier member (e.g., a flexible silicone body). In this specific example, the stimulating assembly 1016 comprises three (3) stimulation electrodes, referred to as stimulation electrodes 1044(1), 1044(2), and 1044(3). The stimulation electrodes 1044(1), 1044(2), and 1044(3) function as an electrical interface for delivery of electrical stimulation signals to the recipient’s vestibular system. It is to be appreciated that this specific embodiment with three stimulation electrodes is merely illustrative and that the techniques presented herein can be used with stimulating assemblies having different numbers of stimulation electrodes, stimulating assemblies having different lengths, etc.

[0085] The stimulating assembly 1016 is configured such that a surgeon can implant the stimulating assembly 1016 adjacent the recipient’s otolith organs via, for example, the recipient’s oval window. As an example, any of the systems (e.g., the system 407, the system 507) discussed herein can be used to implant the stimulating assembly 1016 in the recipient. For instance, the stimulating assembly 1016 is configured to couple to an actuator (e.g., theAtty. Docket No. 3065.0873i Client Ref. No. CID03895WOPC1actuator 411, actuator 511), which operates to implant the stimulating assembly 1016 within a recipient. A stabilizer system (e.g., the stabilizer system 413, the stabilizer system 513) can be used to stabilize the actuator, such as at a target position relative to one or more insertion targets (e.g., the oval window) of the recipient, thereby helping the surgeon implant the stimulating assembly 1016 in the recipient. In additional or alternative embodiments, implantation of the stimulating assembly 1016 in the recipient is automatically controlled via a robot, and the stabilizer system is used to stabilize the stimulating assembly 1016 for implantation in the recipient.

[0086] FIG. 13 illustrates a retinal prosthesis system 1101 (e.g., a visual system) that comprises an external device 1110 configured to communicate with an implantable retinal prosthesis 1100 via signals 1151. The retinal prosthesis 1100 comprises an implanted processing module 1125, and a retinal prosthesis sensor-stimulator 1190 is positioned proximate the retina of a recipient. The external device 1110 and the processing module 1125 can communicate via coils 1108, 1114.

[0087] In an example, sensory inputs (e.g., photons entering the eye) are absorbed by a microelectronic array of the sensor-stimulator 1190 that is hybridized to a glass piece 1192 including, for example, an embedded array of microwires. The glass piece 1192 can have a curved surface that conforms to the inner radius of the retina. The sensor-stimulator 1190 can include a microelectronic imaging device that can be made of thin silicon containing integrated circuitry, which converts the incident photons to an electronic charge.

[0088] The processing module 1125 includes an image processor 1123, which is in signal communication with the sensor-stimulator 1190 via, for example, a lead 1188 extending through surgical incision 1189 formed in the eye wall. In other examples, processing module 1125 is in wireless communication with the sensor-stimulator 1190. The image processor 1123 processes the input into the sensor-stimulator 1190 and provides control signals back to the sensor-stimulator 1190 so the microelectronic imaging device can provide an output to the optic nerve. That said, in an alternate example, the processing is executed by a component proximate to, or integrated with, the sensor-stimulator 1190. The electric charge resulting from the conversion of the incident photons is converted to a proportional amount of electronic current, which is input to a nearby retinal cell layer. The cells fire and a signal is sent to the optic nerve, thus inducing a sight perception.Atty. Docket No. 3065.0873i Client Ref. No. CID03895WOPC1

[0089] The processing module 1125 can be implanted in the recipient and function by communicating with the external device 1110, such as a BTE unit, a pair of eyeglasses, etc. The external device 1110 can include an external light / image capture device (e.g., located in / on a behind-the-ear device or a pair of glasses, etc.), while, as noted above, in some examples, the sensor-stimulator 1190 captures light / images, in which sensor-stimulator 1190 is implanted in the recipient.

[0090] Any of the systems (e.g., the system 407, the system 507) discussed herein can be used to implant a component (e.g., the processing module 1125, the sensor-stimulator 1190) of the retinal prosthesis system 1101 in the recipient by using a stabilizer system (e.g., the stabilizer system 413, the stabilizer system 513) to stabilize an actuator (e.g., the actuator 411, actuator 511) configured to operate to implant the component within the recipient, such as by placing the actuator at a target position relative to an insertion target of the recipient. Indeed, the stabilizer system can help a surgeon manually performing the surgical procedure and / or a robot automatically performing the surgical procedure to implant the retinal prosthesis system 1101 in the recipient.

[0091] FIG. 14 illustrates a tinnitus therapy device 1400 (e.g., a tinnitus implant, a tinnitus management stimulator) including a sound input unit 1402 (e.g., a microphone) configured to receive acoustic inputs. In some embodiments, the sound input unit 1402 is implanted adjacent to an outer ear 1403 to position a diaphragm 1416 of the sound input unit 1402 such that the diaphragm 1416 is configured to be displaced (vibrate) in response to the acoustic inputs. The tinnitus therapy device 1400 further includes an implant body 1404 in which circuitry, such as a processor and / or a memory, is disposed. The implant body 1404 is also coupled to a coil 1408 to enable transfer of power / data between the tinnitus therapy device 1400 and an external device. The implant body 1404 is electrically coupled to the sound input unit 1402 to receive the acoustic input. The tinnitus therapy device 1400 is then configured to convert the acoustic input to tinnitus therapy control signals (e.g., based on a classification of the acoustic input).

[0092] The tinnitus therapy control signals are provided to an actuator 1406 electrically coupled to the implant body 1404 for delivery to the recipient. By way of example, a coupling member 1440 couples the actuator 1406 to an ossicular chain 1436 (i.e., the malleus, the incus, and the stapes bones) positioned in a middle ear cavity between a tympanic membrane 1413 and a cochlea 1430 of the recipient, and the actuator 1406 is configured to deliver the tinnitus therapy control signals. The actuator 1406 is attached to a temporal bone 1415 of the recipient via a fixation system 1442 and is configured to impart motion to (e.g., vibrate) the ossicularAtty. Docket No. 3065.0873i Client Ref. No. CID03895WOPC1chain 1436, which is typically configured to amplify sound waves received via an ear canal 1411. In operation, the actuator 1406 is configured to impart motion based on the tinnitus therapy control signals, and such vibration creates waves of fluid motion of perilymph within the cochlea 1430 to activate hair cells within the cochlea 1430. Activation of the hair cells causes nerve impulses to be generated and transferred through spiral ganglion cells, an auditory nerve, and a brain, where the vibration is perceived as sounds to provide relief of tinnitus symptoms experienced by the recipient.

[0093] A component, such as the implant body 1404, the actuator 1406, the coupling member 1440, and / or the fixation system 1442, of the tinnitus therapy device 1400, can be implanted using any of the systems (e.g., the system 407, the system 507) discussed herein. In particular, an actuator (e.g., the actuator 411, actuator 511) is configured to implant the component within the recipient, and a stabilizer system (e.g., the stabilizer system 413, the stabilizer system 513) can place the actuator at a target position relative to an insertion target of the recipient, thereby helping position the tinnitus therapy device 1400 desirably within the recipient during a surgical procedure (e.g., manually performed by a user, automatically performed by a robot).

[0094] FIG. 15 illustrates an upper airway stimulation device 1500 (e.g., an upper airway implant, a sleep apnea management stimulator, a sleep disorder system) that includes an implant body 1502, a sensor 1504, and a stimulator 1506. The upper airway stimulation device 1500 is implantable in a recipient 1508 to position the sensor 1504 adjacent to lungs 1510 of the recipient 1508. Thus, the sensor 1504 is able to receive input that indicates breathing performed by the recipient 1508. The implant body 1502 includes a housing in which circuitry, such as a processor and / or a memory, is disposed. The sensor 1504 transmits electrical signals in response to receipt of the input, and the upper airway stimulation device 1500 is configured to convert the electrical signals to stimulation signals, which are provided to the stimulator 1506. The stimulator 1506 is positioned adjacent to a hypoglossal nerve 1512 of the recipient 1508 and is configured to deliver the stimulation signals to the hypoglossal nerve 1512, which fires nerve cells of a tongue of the recipient 1508, thereby causing the tongue to contract and move (e.g., in an anterior direction) and increase a size of an opening of an airway of the recipient 1508. Consequently, the upper airway stimulation device 1500 generates stimulation signals based on the input to help the recipient 1508 breathe more easily (e.g., while the recipient 1508 is asleep to mitigate sleep apnea).

[0095] The upper airway stimulation device 1500, such as the implant body 1502, the sensor 1504, and / or the stimulator 1506, can be implanted in the recipient with usage of any of theAtty. Docket No. 3065.0873i Client Ref. No. CID03895WOPC1systems (e.g., the system 407, the system 507) discussed herein. That is, an actuator (e.g., the actuator 411, actuator 511) is configured to implant the upper airway stimulation device 1500 within the recipient, and a stabilizer system (e.g., the stabilizer system 413, the stabilizer system 513) can place the actuator at a target position relative to an insertion target of the recipient, thereby helping position the upper airway stimulation device 1500 desirably within the recipient during a surgical procedure (e.g., manually performed by a user, automatically performed by a robot).

[0096] The above embodiments have been primarily described with reference to use of the techniques presented herein during implantation of a specific implantable component, namely a cochlear implant stimulating assembly. However, as described above with reference to FIGs.12, 13, 14, and 15, the techniques presented herein can be used to provide stabilization during implantation of a variety of implantable components, including sleep disorder devices (e.g., sleep apnea devices), seizure devices (e.g., devices for monitoring and / or treating epileptic events), balance or movement disorder devices (e.g., vestibular stimulation devices), tinnitus management devices, visual implants (e.g., bionic eyes) and other neuromodulation devices (e.g., brain-computer interfaces).

[0097] FIG. 16 is a block diagram illustrating one example arrangement for an external computing device 1610 configured to perform one or more operations in accordance with certain embodiments presented herein. As shown in FIG. 16, in its most basic configuration, the external computing device 1610 includes at least one processing unit 1683 and a memory 1684. The processing unit 1683 includes one or more hardware or software processors (e.g., Central Processing Units) that can obtain and execute instructions. The processing unit 1683 can communicate with and control the performance of other components of the external computing device 1610. The memory 1684 is one or more software or hardware-based computer-readable storage media operable to store information accessible by the processing unit 1683. The memory 1684 can store, among other things, instructions executable by the processing unit 1683 to implement applications or cause performance of operations described herein, as well as other data. The memory 1684 can be volatile memory (e.g., RAM), nonvolatile memory (e.g., ROM), or combinations thereof. The memory 1684 can include transitory memory or non-transitory memory. The memory 1684 can also include one or more removable or non-removable storage devices. In examples, the memory 1684 can include RAM, ROM) EEPROM (Electronically-Erasable Programmable Read-Only Memory), flash memory, optical disc storage, magnetic storage, solid state storage, or any other memory mediaAtty. Docket No. 3065.0873i Client Ref. No. CID03895WOPC1usable to store information for later access. By way of example, and not limitation, the memory 1684 can include wired media, such as a wired network or direct- wired connection, and wireless media, such as acoustic, RF, infrared, other wireless media, or combinations thereof. In certain embodiments, the memory 1684 comprises logic 1695 that, when executed, enables the processing unit 1683 to perform aspects of the techniques presented. For instance, the processing unit 1683 is communicatively coupled to a stabilizer system (e.g., the stabilizer system 413, the stabilizer system 513) and is configured to activate the stabilizer system to place an actuator (e.g., the actuator 411, the actuator 511) at a target position.

[0098] In the illustrated example of FIG. 16, the external computing device 1610 further includes a network adapter 1686, one or more input devices 1687, and one or more output devices 1688. The external computing device 1610 can include other components, such as a system bus, component interfaces, a graphics system, a power source (e.g., a battery), among other components. The network adapter 1686 is a component of the external computing device 1610 that provides network access (e.g., access to at least one network 1689). The network adapter 1686 can provide wired or wireless network access and can support one or more of a variety of communication technologies and protocols, such as Ethernet, cellular, Bluetooth, near-field communication, and RF, among others. The network adapter 1686 can include one or more antennas and associated components configured for wireless communication according to one or more wireless communication technologies and protocols. The one or more input devices 1687 are devices over which the external computing device 1610 receives input from a user. The one or more input devices 1687 can include physically-actuatable user-interface elements (e.g., buttons, switches, or dials), a keypad, keyboard, mouse, touchscreen, and voice input devices, among other input devices that can accept user input. The one or more output devices 1688 are devices by which the external computing device 1610 is able to provide output to a user. The output devices 1688 can include a display 1690 (e.g., a liquid crystal display (LCD)) and one or more speakers 1691, among other output devices for presentation of visual or audible information to the recipient, a clinician, an audiologist, or other user.

[0099] It is to be appreciated that the arrangement for the external computing device 1610 shown in FIG. 16 is merely illustrative and that aspects of the techniques presented herein can be implemented at a number of different types of systems / devices including any combination of hardware, software, and / or firmware configured to perform the functions described herein. For example, the external computing device 1610 can be a personal computer (e.g., a desktop or laptop computer), a hand-held device (e.g., a tablet computer), a mobile device (e.g., aAtty. Docket No. 3065.0873i Client Ref. No. CID03895WOPC1smartphone), a surgical system, and / or any other electronic device having the capabilities to perform the associated operations described elsewhere herein.[ooioo] As should be appreciated, while particular uses of the technology have been illustrated and discussed above, the disclosed technology can be used with a variety of devices in accordance with many examples of the technology. The above discussion is not meant to suggest that the disclosed technology is only suitable for implementation within systems akin to that illustrated in the figures. In general, additional configurations can be used to practice the processes and systems herein and / or some aspects described can be excluded without departing from the processes and systems disclosed herein.[ooioi] This disclosure described some aspects of the present technology with reference to the accompanying drawings, in which only some of the possible aspects were shown. Other aspects can, however, be embodied in many different forms and should not be construed as limited to the aspects set forth herein. Rather, these aspects were provided so that this disclosure was thorough and complete and fully conveyed the scope of the possible aspects to those skilled in the art.

[0102] As should be appreciated, the various aspects (e.g., portions, components, etc.) described with respect to the figures herein are not intended to limit the systems and processes to the particular aspects described. Accordingly, additional configurations can be used to practice the methods and systems herein and / or some aspects described can be excluded without departing from the methods and systems disclosed herein.

[0103] According to certain aspects, systems and non-transitory computer readable storage media are provided. The systems are configured with hardware configured to execute operations analogous to the methods of the present disclosure. The one or more non-transitory computer readable storage media comprise instructions that, when executed by one or more processors, cause the one or more processors to execute operations analogous to the methods of the present disclosure.

[0104] Similarly, where steps of a process are disclosed, those steps are described for purposes of illustrating the present methods and systems and are not intended to limit the disclosure to a particular sequence of steps. For example, the steps can be performed in differing order, two or more steps can be performed concurrently, additional steps can be performed, and disclosed steps can be excluded without departing from the present disclosure. Further, the disclosed processes can be repeated.Atty. Docket No. 3065.0873i Client Ref. No. CID03895WOPC1

[0105] Although specific aspects were described herein, the scope of the technology is not limited to those specific aspects. One skilled in the art will recognize other aspects or improvements that are within the scope of the present technology. Therefore, the specific structure, acts, or media are disclosed only as illustrative aspects. The scope of the technology is defined by the following claims and any equivalents therein.

[0106] It is also to be appreciated that the embodiments presented herein are not mutually exclusive and that the various embodiments can be combined with another in any of a number of different manners.

Claims

Atty. Docket No. 3065.0873i Client Ref. No. CID03895WOPC1CLAIMSWhat is claimed is:

1. A system for inserting a stimulating assembly into a recipient, the system comprising:a base;an actuator configured to couple to the stimulating assembly and to drive movement of the stimulating assembly into the recipient; anda stabilizer system coupling the actuator to the base, wherein the stabilizer system is configured to stabilize the actuator relative to one or more insertion targets.

2. The system of claim 1, wherein the stabilizer system includes a processor configured to:determine a target position of the actuator relative to the one or more insertion targets; detect movement of the base; andin response to the detected movement of the base, activate the stabilizer system to place the actuator at the target position relative to the one or more insertion targets.

3. The system of claim 2, wherein the stabilizer system comprises a plurality of gimbal motors, and wherein the processor is configured to activate the stabilizer system by driving at least one gimbal motor of the plurality of gimbal motors to point or move the actuator toward the target position in response to detecting the movement of base.

4. The system of claim 3, wherein the processor is configured to detect the movement of the base based on an inertial rotation of the at least one gimbal motor of the plurality of gimbal motors, and the processor is configured to drive the at least one gimbal motor of the plurality of gimbal motors to rotate to counteract the inertial rotation to move the actuator toward the target position in response to detecting the movement of the base.

5. The system of claim 2, wherein the stabilizer system comprises a plurality of linear motors, and the processor is configured to activate the stabilizer system by driving at least one linear motor of the plurality of linear motors to translate to move the actuator toward the target position in response to detecting the movement of the base.Atty. Docket No. 3065.0873i Client Ref. No. CID03895WOPC16. The system of claim 5, wherein the target position comprises a set position with respect to a plurality of reference points, and the processor is configured to:drive the at least one linear motor of the plurality of linear motors to move the actuator toward the set position with respect to the plurality of reference points.

7. The system of claim 1, 2, 3, 4, 5, or 6, wherein the base is configured to mount to a surface.

8. The system of claim 1, 2, 3, 4, 5, or 6, wherein the base is a handheld base.

9. A use of the system according to any one of claims 1, 2, 3, 4, 5, 6, 7, or 8 to implant the stimulating assembly in the recipient for a sleep disorder system, a seizure system, a balance or movement disorder system, a tinnitus management system, or a visual system.

10. The system of claim 1, 2, 3, 4, 5, or 6, wherein the one or more insertion targets includes an opening to an inner ear of the recipient.

11. A method, comprising:determining a target position of an actuator configured to impart linear motion to a stimulating assembly during insertion of the stimulating assembly into a recipient;detecting movement of the actuator from the target position; andactivating a stabilizer system coupled to the actuator to move the actuator toward the target position in response to detecting the movement of the actuator from the target position.

12. The method of claim 11, comprising:receiving a plurality of reference points;receiving a set position relative to the plurality of reference points; and establishing the set position relative to the plurality of reference points as the target position.

13. The method of claim 11 , wherein detecting the movement of the actuator from the target position comprises determining a vector between the actuator and the target position.Atty. Docket No. 3065.0873i Client Ref. No. CID03895WOPC114. The method of claim 11, 12, or 13, wherein detecting the movement of the actuator from the target position comprises determining unintentional movement of a motor of the stabilizer system.

15. The method of claim 14, wherein activating the stabilizer system to move the actuator toward the target position in response to detecting the movement of the actuator from the target position comprises driving the motor to counteract the unintentional movement of the motor of the stabilizer system.

16. The method of claim 11, 12, or 13, wherein activating the stabilizer system to move the actuator toward the target position in response to detecting the movement of the actuator from the target position comprises driving a motor of the stabilizer system to translate the actuator toward the target position.

17. The method of claim 11, 12, or 13, wherein activating the stabilizer system to move the actuator toward the target position in response to detecting the movement of the actuator from the target position comprises driving a motor of the stabilizer system to rotate the actuator toward the target position.

18. The method of claim 11, 12, or 13, wherein the target position comprises a dynamic target position with respect to the recipient.

19. The method of claim 18, comprising:determining a position of the stimulating assembly with respect to the recipient; updating the dynamic target position based on the position of the stimulating assembly with respect to the recipient to provide an updated target position; andactivating the stabilizer system to move the actuator toward the updated target position.

20. The method of claim 11, 12, or 13, comprising:actuating the actuator to insert the stimulating assembly within the recipient.Atty. Docket No. 3065.0873i Client Ref. No. CID03895WOPC121. A system, comprising:an implantable component;an actuator coupled to the implantable component and configured to drive movement of the implantable component for implantation in a recipient;a stabilizer system coupled to the actuator, wherein the stabilizer system is configured to stabilize the actuator relative to one or more unintentional movements; anda processor communicatively coupled to the stabilizer system and configured to activate the stabilizer system to counteract application of at least one unintentional movement urging the actuator away from a target position.

22. The system of claim 21, wherein the processor is configured to detect movement of the actuator from the target position and activate the stabilizer system in response to detecting movement of the actuator from the target position to counteract the at least one unintentional movement urging the actuator away from the target position.

23. The system of claim 22, wherein the processor is configured to detect movement of the actuator from the target position by determining a direction between the actuator and the target position.

24. The system of claim 21, 22, or 23, wherein the stabilizer system comprises a motor, and the processor is configured to activate the stabilizer system to counteract the at least one unintentional movement urging the actuator away from the target position by driving movement of the motor.

25. The system of claim 24, wherein the processor is configured to drive movement of the motor to move the actuator toward the target position.

26. The system of claim 24, wherein the processor is configured to drive movement of the motor to maintain positioning of the actuator at the target position.

27. The system of claim 21, 22, or 23, comprising a sensor, wherein the processor is configured to activate the stabilizer system to counteract the at least one unintentional movement urging the actuator away from the target position based on feedback received from the sensor.Atty. Docket No. 3065.0873i Client Ref. No. CID03895WOPC128. The system of claim 27, wherein the feedback received from the sensor comprises at least one of movement of the stabilizer system or a position of the actuator in space.

29. The system of claim 21, 22, or 23, wherein the actuator is configured to impart linear motion on the implantable component to drive movement of the implantable component for implantation in the recipient.

30. The system according to claims 21, 22, 23, 24, 25, 26, 27, 28, or 29, wherein the system is a cochlear implant system, a sleep disorder system, a seizure system, a balance or movement disorder system, a tinnitus management system, or a visual system.

31. A method, comprising:determining one or more insertion targets for use during implantation of an implantable component into a recipient, wherein the implantable component is mechanically coupled to an insertion system comprising a stabilizer system and an actuator to move the implantable component; andwhile implanting the implantable component into the recipient, maintaining, via the stabilizer system, a relative positional relationship between at least one of the implantable component or the actuator and the one or more insertion targets.

32. The method of claim 31, wherein maintaining the relative positional relationship between the at least one of the implantable component or the actuator and the one or more insertion targets comprises:detecting, via one or more sensors of the stabilizer system, unintentional movement of the implantable component or the actuator; andautomatically activating the stabilizer system to counteract the unintentional movement of the implantable component or the actuator.Atty. Docket No. 3065.0873i Client Ref. No. CID03895WOPC133. The method of claim 31 or 32, wherein maintaining the relative positional relationship between the at least one of the implantable component or the actuator and the one or more insertion targets comprises:determining a target position for the at least one of the implantable component or the actuator relative to the one or more insertion targets;detecting movement of the actuator from the target position; andactivating the stabilizer system to move the actuator toward the target position in response to detecting the movement of the actuator from the target position.

34. The method of claim 33, wherein maintaining the relative positional relationship between the at least one of the implantable component or the actuator and the one or more insertion targets comprises:receiving a plurality of reference points;receiving a set position relative to the plurality of reference points; and establishing the set position relative to the plurality of reference points as the target position.

35. The method of claim 31 or 32, wherein the one or more insertion targets include a reference point in the recipient.

36. The method of claim 35, wherein the reference point is an opening in an inner ear of the recipient.

37. The method of claim 31 or 32, wherein the implantable component is a stimulating assembly.

38. The method of claim 31 or 32, wherein the implantable component is a component of a cochlear implant system, a sleep disorder system, a seizure system, a balance or movement disorder system, a tinnitus management system, or a visual system.

39. A use of a method according to any one of claims 31-37 in a cochlear implant system, a sleep disorder system, a seizure system, a balance or movement disorder system, a tinnitus management system, or a visual system.

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