Abstract:
Systems and methods are disclosed for insertion of implantable medical devices, and more particularly to insertion of implantable devices with a vibrating insertion tool. More specifically, a vibrating insertion tool is described, the insertion tool comprising an insertion tool controllable by a user to support and guide movement of an object, the insertion tool comprising an elongate arm having a proximal end region and a distal end region, the distal end region having a receiving region, a user-controllable vibration source for generating vibrations in accordance with a selected vibration profile, and an elongate rigid spine, connected to the vibration source and the receiving region, configured to deliver the vibrations to the receiving region.

Description:
FIELD OF THE TECHNOLOGY 
       [0001]    The present technology relates generally to insertion of implantable medical devices, and more particularly, to insertion of implantable medical devices with a vibrating insertion tool. 
       BACKGROUND 
       [0002]    Hearing loss, which may be due to many different causes, is generally of two types, conductive and sensorineural. Sensorineural hearing loss occurs when there is damage to the inner ear, or to the nerve pathways connecting the inner ear to the brain. Conductive hearing loss occurs when the normal mechanical pathways that provide sound to the cochlea are impeded, for example, by damage to the ossicular chain or ear canal. However, individuals suffering from conductive hearing loss may retain some form of residual hearing because the hair cells in the cochlea may remain undamaged. As a result, individuals suffering from conductive hearing loss typically receive a hearing prosthesis that generates mechanical motion of the cochlea fluid. Still other individuals suffer from mixed hearing losses, that is, conductive hearing loss in conjunction with sensorineural hearing. Such individuals may have damage to the outer or middle ear, as well as to the inner ear (cochlea). Individuals suffering from conductive hearing loss typically receive an acoustic hearing aid. Unfortunately, not all individuals suffering from conductive hearing loss are able to derive suitable benefit from hearing aids. 
         [0003]    Another type of hearing prosthesis is a cochlear implant. Cochlear implants provide electrical stimulation via, e.g. an electrode assembly with stimulating electrode contacts positioned as close as possible to the auditory nerve, essentially bypassing the cochlear hair cells. The application of a stimulation pattern to the nerve endings causes impulses to be sent to the brain via the auditory nerve, resulting in the brain perceiving the impulses as sound. 
         [0004]    Insertion of a cochlear implant electrode assembly may cause trauma to the recipient&#39;s cochlea. For example, when a surgeon inserts an electrode assembly into the scala tympani, the basilar membrane may be bruised, punctured or torn. Such physical trauma may lead to a temporary or permanent change in the recipient&#39;s residual hearing characteristics. 
       SUMMARY 
       [0005]    In one aspect, there is provided a vibrating insertion tool comprising: an insertion tool controllable by a user to support and guide movement of an object, the insertion tool comprising an elongate arm having a proximal end region and a distal end region, the distal end region having a receiving region; a user-controllable vibration source for generating vibrations in accordance with a selected vibration profile; and an elongate rigid spine, connected to the vibration source and the receiving region, configured to deliver the vibrations to the receiving region. 
         [0006]    In another aspect, there is provided an integrated vibration system for an insertion tool comprising: a user-controllable vibration source for generating first vibrations in accordance with a selected vibration profile; and an elongate vibration transfer member configured to deliver second vibrations to a receiving region of the insertion tool, wherein second vibrations are delivered in accordance with substantially the same vibration profile as the selected vibration profile. 
         [0007]    In another aspect, there is provided a method for inserting a medical device into a recipient using a vibrating insertion tool, comprising: attaching an integrated vibration system to the insertion tool; engaging the medical device with the insertion tool; inserting the medical device into the recipient; generating a control signal that defines a selected vibration profile; and generating vibrations, via the control signal, in accordance with the desired vibration profile during one or more user-defined periods during the insertion of the medical device. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0008]    Embodiments of the present technology are described below with reference to the attached drawings, in which: 
           [0009]      FIG. 1A  is a perspective view of an exemplary vibrating insertion tool, according to embodiments of the present technology; 
           [0010]      FIG. 1B  is side view of an exemplary vibrating insertion tool, according to embodiments of the present technology; 
           [0011]      FIG. 2  is a perspective view of an elongated spine member including a dog leg shaped portion, according to embodiments of the present technology; 
           [0012]      FIG. 3A  is a side view of an exemplary vibrating insertion tool, according to embodiments of the present technology; 
           [0013]      FIG. 3B  is a perspective view of the exemplary vibrating insertion tool of  FIG. 3A , according to embodiments of the present technology; 
           [0014]      FIG. 4A  is a perspective view of another exemplary vibrating insertion tool, according to embodiments of the present technology; 
           [0015]      FIG. 4B  is a perspective view of another exemplary vibrating insertion tool, according to embodiments of the present technology; 
           [0016]      FIG. 5  is a graph that shows plots of insertion forces with respect to insertion depth applied to the cochlea structures by a non-vibrating insertion tool, and by a vibrating insertion tool according to embodiments of the present technology; 
           [0017]      FIG. 6A  is a cross-sectional view of a vibration source and its physical relationship with a junction of an exemplary insertion tool and spine member, according to embodiments of the present technology; and 
           [0018]      FIG. 6B  is a block diagram illustrating the control features, according to embodiments of the present technology. 
       
    
    
     DETAILED DESCRIPTION 
       [0019]    Aspects and embodiments of the present technology are directed to a vibrating insertion tool for inserting an implantable medical device, such as an electrode assembly, into the cochlea of a recipient. 
         [0020]    The vibrating insertion tool includes an insertion tool with an integrated vibration system. The insertion tool may include a forceps, tweezers, surgical claws, or any other suitably configured tool that supports or receives a medical device for implantation. The vibration system includes a vibration source attached to the insertion tool, and a vibration coupling member that couples the vibration source to the tool, e.g. a distal location of the tool proximate the location of the tool that contacts the medical device. This vibration coupling member, referred to herein as, for example, a spine efficiently transfers vibrations generated by the vibration source to the region of the device that receives the medical device. In use, such vibrations are transferred to the medical device supported by the insertion tool. The vibrations from the vibrating insertion tool allow a surgeon to implant the medical device to a desired depth with a minimized insertion force, or a level of insertion force that causes less trauma to the recipient. 
         [0021]    To efficiently deliver vibrations generated by the vibration source to the device receiving region of the insertion tool, the spine is connected to both the vibration source and a distal end of the insertion tool. Since the spine is attached to the insertion tool, contact between a surgeon using the insertion tool and the insertion tool itself may cause dampening of the vibrations traveling through the spine and may cause an unwanted effect of altering the vibration characteristics profile of the vibrating insertion tool as a whole. As such, the disclosed vibrating insertion tool includes the maximization of the decoupling or isolation of the insertion tool from the vibration-carrying spine until the spine transfers the vibrations to a specific receiving region of the insertion tool. 
         [0022]    Furthermore, as noted, insertion forces applied to the internal structures of the cochlea can lead to cochlea trauma. Due to the vibrating of the insertion tool using the vibration source, such trauma to the cochlea of the recipient can minimized. More specifically, the inventors have further determined that implementing certain specific vibration profiles with the disclosed vibrating insertion tool helps to minimize insertion forces and as such reduce the risk of trauma. More specifically, a controller drives the vibration source to vibrate with a certain vibration profile, i.e. at a certain frequency and amplitude. During implantation, the surgeon can adjust such vibration characteristics via a user interface of the controller. Although successively higher vibration frequencies and successively greater vibration amplitudes will facilitate insertion of the medical device using successively smaller insertion forces, to ensure efficacy, a maximum vibration frequency and amplitude are enforced by the controller. In addition, the controller has vibration profiles for each of a variety of surgical circumstances, that is, the optimal vibration characteristics that enable the surgeon to implant the device using the minimal insertion force. These optimal vibration profiles vary according to the medical device, tool, fundamental frequency of the tool with the device, the surgical environment and the surgeon&#39;s manual technique, among other factors. Additional vibration profiles may be provided in the controller to accommodate each of these and other conditions. 
         [0023]      FIG. 1A  is a perspective view and  FIG. 1B  is a side view of an exemplary vibrating insertion tool  100 , according to embodiments of the present technology. Vibrating insertion tool  100  includes a first arm or shaft  102 A and a second arm or shaft  102 B. First arm  102 A and second arm  102 B join together at junction  108 . First arm  102 A includes a tip  104 A, which is located towards the distal portion  118 A of first arm  102 A, and second arm  102 B includes a tip  104 B, which is located towards the distal portion  118 B of second arm  102 B. Vibrating insertion tool  100  also includes a handle region or portion  114 , which is divided between first arm  102 A and second arm  102 B. As such, first arm  102 A includes handle region  114 A and second arm  102 B includes handle region  114 B. 
         [0024]    Vibrating insertion tool  100  is used by a surgeon to support or receive (e.g. grasp and/or hold) an object before, during or after surgery, and more specifically, for example, vibrating insertion tool  100  is used for inserting an implantable medical device, such as an electrode assembly, into the cochlea of a recipient. The surgeon may hold vibrating insertion tool  100  anywhere along handle region  114  between junction  108  and tips  104 A and  104 B. Tips  104 A and  104 B are brought together, to grasp an object, by squeezing arms  102 A and  102 B together until tips  104 A and  104 B capture the object between them. 
         [0025]    Vibrating insertion tool  100  also includes an elongated vibration coupling member or rigid spine member  110  and a vibration source  112 , as shown in  FIGS. 1A and 1B . Spine member  110  is positioned between first arm  102 A and second arm  102 B. Spine member  110  may be shaped similarly to first arm  102 A and/or second arm  102 B. In such an embodiment, spine member  110  may overlap tips  104  so that when vibrating insertion tool  100  receives a medical device to be implanted, spine member  110  is in direct contact with the medical device. Spine member  110  may also be slightly shorter in length than arms  102  (such that, for example, spine member  110  extends down the length of first arm  102 A and/or second arm  102 B but does not overlap with tips  104 , as shown in  FIG. 1A ). However, alternatively, spine member  110  may have a variety of other shapes, lengths and widths than those shown in  FIG. 1A . 
         [0026]    Spine member  110  is coupled to vibration source  112  such that vibrations from vibration source  112  are transferred to spine member  110 . Spine member  110  also extends away from arms  102 A and  102 B so as to connect with vibration source  112 . For example, spine member  110  may include a dog leg shaped portion  120  to extend beyond its location in between arms  102 A and  102 B, as shown in  FIG. 1B  and  FIG. 2 . According to embodiments of the present technology, vibration source  112  is connected to spine member  110  such that vibration source  112  is located towards the proximal end of vibrating insertion tool  100 . It may be preferable for vibration source  112  to be located towards the proximal end of insertion tool  100  to avoid vibration source  112  from interfering with the surgeon&#39;s use of vibrating insertion tool  100  and/or avoid vibration source  112  blocking the surgeon&#39;s view of tips  104 A and  104 B or the surgery site during surgery. However, it should be understood that vibration source  112  may be located in various other locations with respect to vibrating insertion tool  100 , including anywhere along the length of vibrating insertion tool  100  or remote from vibrating insertion tool  100  via, for example, the use of a longer spine member  110 , without affecting a surgeon&#39;s use of insertion vibrating insertion tool  100 . An exemplary vibration source  112  and its physical relationship with spine member  110  is discussed further with respect to  FIG. 6A . 
         [0027]      FIG. 2  is a perspective view of elongated spine member  110  including dog leg shaped portion  120 , according to embodiments of the present technology. As shown in  FIG. 2 , spine member  110  may be connected to a vibration source holder  222  that secures vibration source  112  in place with respect to spine member  110 . Vibration source holder  222  may be in the shape of a fork, such as fork  206  including plate  208  and tines  210 A and  210 B. In such an embodiment, vibration source  112  may be secured in between tines  210 A and  210 B. As such, the distance between tines  210 A and  210 B may be slightly smaller than the width of vibration source  112  such that tines  210 A and  210 B tightly hold vibrations source  112  in place. 
         [0028]      FIG. 3A  is a side view, and  FIG. 3B  is a close-up perspective view, of an exemplary vibrating insertion tool  300 , according to embodiments of the present technology. As shown in  FIGS. 3A and 3B , spine member  110  is runs substantially parallel with arm  102 A, but does not come into direct contact with arm  102 A. Instead, spine member  110  and arm  102 A are separated by a separator  324  (alternatively, spine member  110  may be connected to arm  102 B, or there may be a second spine member connected to arm  102 B). In this embodiment, separator  324  may be made of neoprene, rubber, or other elastomeric or similar material in the form of, for example, a grommet or O-ring, or any other at least semi-flexible or malleable material capable of holding spine member  110  to arm  102 A and transferring vibrations from spine member  110  to arm  102 A. Separator  324  used within embodiments of the present technology may also be more rigid, as will be discussed further. Separator  324  decouples, or isolates, spine member  110  from arm  102 A. As noted, contact between the spine and a surgeon using the insertion tool or the insertion tool itself may cause dampening of the vibrations traveling through the spine and may cause an unwanted effect of altering the vibration characteristics profile of the vibrating insertion tool as a whole. For example, when a surgeon grasps handle portion  114 , and therefore applies force to handle portion  114 A of arm  102 A, such dampening of any vibrations traveling through arm  102 A or traveling through a member coupled to arm  102 A may occur. Separator  324  allows vibrating insertion tool  100  to avoid such a rigid coupling. Since separator  324  isolates spine member  110 , through which vibrations travel, from arm  102 A through the portion of arm  102 A at which the surgeon would grasp arm  102 A, such dampening effect would be controlled and minimized or eliminated. In other words, vibrating insertion tool  300  includes a substantially unimpeded path, via spine member  110 , through which to travel to the surgeon&#39;s desired receiving region. As such, vibrations being transferred by spine member  110  from vibration source  112  to the receiving region may be transferred to the implantable medical device without being substantially dampened. 
         [0029]    Separator  324  may act as a dampener itself. However, the use of separator  324  allows for the majority of the space between spine member  110  and arm  102 A to consist of empty space, or an air gap. Therefore, although separator  324  may be formed into various shapes and sizes other than those shown in, for example,  FIG. 3B , it may be beneficial for separator  324  to be a small as possible while still strong enough to couple spine member  110  to arm  102 A such that the dampening effect of separator  324  is as small as possible. 
         [0030]    Furthermore, separator  324  facilitates the indirect physical coupling of spine member  110  and arm  102 A. As noted, the vibrating insertion tool, and spine member  110 , transfers vibrations generated by the vibration source to a specific, predetermined portion, or the receiving region, of the insertion tool. As shown in  FIG. 3A , spine member  110  connects to arm  102 A through separator  324  at such a specific receiving region of the insertion tool, such as, for example, tip  104 A. In other words, because spine member  110  does not physically connect to arm  102 A at any point except through separator  324 , vibrations traveling through spine member  110  do not transfer to arm  102 A at points along arm  102 A other than at the selected receiving region. Since spine member  110  transfers vibrations to arm  102 A at the selected receiving region of arm  102 A, other portions of arm  102 A (and of the rest of the insertion tool) will not directly receive vibrations and therefore may only vibrate in limited amounts due to residual vibrations that travel from the receiving region to the other portions. In other words, this permits the receiving region to vibrate together with spine member  110  substantially independently of arm  102 A and the rest of the insertion tool (such as, for example, handle region  114 ). 
         [0031]    Separator  324  is located, as shown in  FIG. 3A  for example, close to the end of arm  102 A at tip  104 A. However, separator  324  may be located in different positions along arm  102 A, and therefore spine member  110  may be coupled to arm  102 A at different positions along arm  102 A. Such a position may be chosen in order to allow for the transfer of vibrations from spine member  110  to a different receiving region of arm  102 A. Referring back to  FIG. 1A , as shown in  FIG. 1A , for example, spine  110  may be shorter than arm  102 A such that spine member  110  is coupled to arm  102 A at a position along arm  102 A other than tip at  104 A. In such an embodiment, when the vibrating insertion tool receives a medical device to be implanted, the insertion tool is in direct contact with the medical device instead of spine member  110 . Therefore, vibrations transferred through spine member  110  would be transferred from spine member  110  to arm  102 A, and then from arm  102 A to the implantable medical device. In such an embodiment, if a separator such as separator  324  is used, separator  324  may be a rigid separator that rigidly or hard couples spine member  110  to arm  102 A. For example, spine member  110  may be welded to arm  102 A via separator  324 . The connection between spine member  110  and arm  102 A may be rigid so that vibrations being carried by spine member  110  are transferred efficiently to arm  102 A and subsequently to the medical device received by the vibrating medical device and to be implanted into the recipient.  FIG. 4B  also provides an alternative embodiment including a spine member with a hole  112  that receives a stud  403  of arm  102 A. Such an embodiment may also include a rigid connection between spine member  110  and arm  102 A where the connection, and receiving region, is located on arm  102 A in a location proximal to the tip of the vibrating insertion tool. 
         [0032]    Vibrating insertion tool  300  may also include more than one separator. For example, vibrating insertion tool  300  may include a first separator that couples spine member  110  to arm  102 A at tip  104 A, and another separator that couples spine member  110  to arm  102 A at a different predetermined position along spine member  110  and arm  102 A. Using multiple separators may provide more stability for the combination of spine member  110  and arm  102 A, and prevent spine member  110  from moving away from arm  102 A unexpectedly when a force is applied to either spine member  110  or arm  102 A, either by accident or on purpose. Furthermore, as noted, separator  324  may be formed into various shapes and sizes other than those shown in, for example,  FIG. 3B . For example, the width of separator  324  may be smaller than the width of arm  102 A, as shown in  FIG. 4 . 
         [0033]      FIG. 4A  is a close-up perspective view of an exemplary vibrating insertion tool  400 , according to embodiments of the present technology. Similar to vibrating insertion tool  300  in  FIG. 3A  and  FIG. 3B , vibrating insertion tool  400  includes arms  102 A and  102 B, spine member  110  and separator  324 . However, vibrating insertion tool  400  differs from vibrating insertion tool  300  in that arm  102 A of vibrating insertion tool  400  includes a pocket or recess  426  in which separator  324  and spine member  110  fit. Furthermore, arm  102 A of vibrating insertion tool  400  may include stop members, such as stop members  428 . Stop members  428  may prevent vibrating spine member  110  from moving too far in a direction perpendicular to the longitudinal axis of arm  402 A. 
         [0034]    The separator  324  shown in  FIGS. 3A-4B  are used to connect spine member  110  to arm  102 A at the receiving region (and subsequently isolate the rest of the vibrating spine from the rest of arm  102 A), a separator like material may also be used on the outside of arms  102 A and/or  102 B, such as on handle  114 A and  114 B. Such a separator may be used to isolate or decouple the surgeon&#39;s hand from directly contacting the insertion tool. Isolating the surgeon from the insertion tool may substantially reduce or prevent dampening of the vibrations transferred through the spine and may also prevent cause an unwanted effect of substantially altering the vibration characteristics profile of the vibrating insertion tool. Furthermore, such a separator may prevent vibrations from affecting the surgeon&#39;s handling during surgery. 
         [0035]      FIG. 4B  is a close-up perspective view of another exemplary vibrating insertion tool  401 , according to embodiments of the present technology. Vibrating insertion tool  401  includes arms  402 A and  402 B. Arm  402 A is similar to vibrating insertion tools disclosed herein e.g. vibrating insertion tool  100  from  FIG. 1A , except that arm  402 A also includes a stud protruding from the inside of arm  402 A. As shown in  FIG. 1A , spine  110  includes a hole  112  (although in different embodiments spine  110  may not include hole  112 , such as in  FIG. 3A ). As shown in  FIG. 4B , stud  403  of arm  402 A may protrude into a hole within spine  110 . The interlocking relationship between stud  403  and hole  112  allows for a physical connection between spine  110  and arm  402 A. Consistent with the goal of transmitting vibrations from spine  110  to a receiving region of arm of the vibrating insertion tool, hole  112  and corresponding stud  403  may be located at or near the receiving region such that vibrations may transfer from spine  110  to stud  403  at the receiving region to, as noted, preserve the characteristics of the vibration profile of the vibrations being transferred. 
         [0036]    As noted, insertion forces applied to the internal structures of the cochlea can lead to cochlea trauma and such trauma to the cochlea of the recipient can minimized by vibrating of the insertion tool while being used by the surgeon.  FIG. 5  is a graph that shows plots of insertion forces (in Newtons), with respect to insertion depth (in millimeters), applied to the cochlea structures by a non-vibrating insertion tool and by an exemplary vibrating insertion tool as disclosed herein. The insertion depth, which is plotted in millimeters, is also shown in insertion stages (stages 1 through 5), where stage 1 represents the earliest (and most shallow) portion of the insertion process and stage 5 represents the latest (and deepest) portion of the insertion process.  FIG. 5  shows plots  604 A,  604 B and  604 C, which each represent a plot from data taken upon the insertion of a non-vibrating insertion tool, such as those present in the prior art. The three plots  604 A,  604 B and  604 C differ in that the data to create each plot was taken during different tests of such a non-vibrating insertion tool. On the other hand, plots  602 A,  602 B and  602 C each represent a plot from data taken upon the insertion of a vibrating insertion tool according to embodiments of the present technology. The three plots  602 A,  602 B and  602 C differ in that the data to create each plot was taken during different tests of such a vibrating insertion tool. As shown in  FIG. 5  when comparing plots  604 , representing exemplary insertion force data for a non-vibrating insertion tool, and plots  602 , representing exemplary insertion force data for a vibrating insertion tool, the insertion force created by a non-vibrating insertion tool is significantly higher than by a vibrating insertion tool in accordance with embodiments of the present technology. More specifically, at each marked insertion depth 1 through 5, the insertion force of the non-vibrating insertion tool is higher than the corresponding insertion force of the vibrating insertion tool at the same insertion depth. For example, the insertion force data for the exemplary non-vibrating insertion tool at insertion depth stage 4 show insertion forces of approximately 0.26 N, 0.24 N and 0.17 N for plots  604 A,  604 B and  604 C, respectively. On the other hand, the insertion force data for the exemplary vibrating insertion tool of the present technology at the same insertion depth stage 4 show insertion forces of approximately 0.08, 0.08 and −0.01 for plots  602 A,  602 B and  602 C, respectively. Therefore, due to the vibrating of the insertion tool instead of a non-vibrating insertion tool, trauma to the cochlea of the recipient due to insertion of a medical device can minimized. 
         [0037]    Furthermore, the inventors have further determined that implementing certain specific vibration profiles with the disclosed vibrating insertion tool helps to maximize the effectiveness of the vibrations transferred by the insertion tool to the medical device to be implanted so as to minimize the insertion force necessary, and therefore minimize any trauma experienced by the recipient. For example, a vibration profile may include the axis of vibration (e.g. along an axis longitudinal to the spine, along an axis perpendicular or otherwise transverse to the spine, rotational, or a combination of the three), the amplitude of the vibrations and the frequency of the vibrations, among others. For example, plots  602 A,  602 B and  602 C in  FIG. 5  represent data from a vibrating insertion tool according to embodiments of the present technology, as noted, and where the vibration source is vibrating along an axis longitudinal to the spine. Furthermore, plot  602 A represents data from such an insertion tool with a vibration profile of 200 Hz frequency and 2 V amplitude, plot  602 B represents data from such an insertion tool with a vibration profile of 100 Hz frequency and 2 V amplitude, and plot  602 C represents data from such an insertion tool with a vibration profile of 200 Hz frequency and 2 V amplitude. However, there is not one vibration profile that would maximize the effectiveness of the vibrating insertion tool in all surgical situations. Instead, the vibration profiles are variable based on various factors or circumstances. For example, an ideal vibration profile for a certain surgical situation may be influenced by any one or more of the following factors: the type and dimensions of the insertion tool being used, the size of the surgeon&#39;s hand, the surgeon&#39;s grip on the insertion tool, the geometry of the patient, the type of surgery being performed including the surgeon&#39;s manual surgical technique, the fundamental frequency of the tool with the device, the medical device being implanted (e.g. electrode assembly), the insertion technique (e.g. standard insertion technique (SIT), advance off stylet insertion technique (AOS), etc.), the surgical environmental conditions, among other variables. An ideal vibration profile may include a frequency of between 100 Hz and 200 Hz and an amplitude of between 1 V and 2 V. However, ideal vibration profiles may extend outside of those ranges. A surgeon using the vibrating insertion tool may adjust the vibration profile during surgery when one or more of the factors changes over time. This surgeon adjustment is discussed further with respect to  FIG. 6B . 
         [0038]      FIG. 6A  is a close-up cross-sectional view of vibration source  112  and its physical relationship with junction  108  of an exemplary insertion tool and spine member  110 , according to embodiments of the present technology. As noted, spine member  110  is coupled to vibration source  112  such that vibrations from vibration source  112  are transferred to spine member  110 . As shown in  FIG. 6A , spine member  110  is connected to vibration source  112  via plate  208 . Referring back to  FIG. 2 , spine member  110  may be connected to a vibration source holder  222 , which includes plate  208 , and secures vibration source  112  in place with respect to spine member  110 . However, spine member  110  may be connected to vibration source  112  using a variety of different techniques, as would be understood by a person of ordinary skill in the art. 
         [0039]    Vibration source  112  includes a housing  610 , a mass  612  and a vibrating transducer  602 , where mass  612  and transducer  602  are located inside housing  610 . It may be desirable to couple a mass to the transducer to facilitate operation of the device and increase the amplitude of motion induced by the transducer. Transducer  602  is coupled to plate  208  such that when transducer  602  vibrates, it transfers such vibrations to plate  208  and subsequently to spine member  110 . Vibration source  112  also includes a conductive element  614  that extends from the inside of housing  610  of vibration source  112  to the outside of housing  610 . Conductive element  614  may be a wire or any other element that is configured to carry driver and/or control signals into the vibration source, for example to drive transducer  602 , from a controller module or other external devices. 
         [0040]      FIG. 6B  is a block diagram illustrating the control features of embodiments of the present technology. As noted, a surgeon using the vibrating insertion tool may adjust the vibration profile during surgery when one or more of the factors changes over time. Controller  702 , which may be included in the vibration source  112  itself or may be an external component, controls the characteristics of the vibration source  112 . For example, controller  702  sends driver or control signals  718  to vibration source  112  to instruct vibration source  112  as to the vibration characteristics that vibration source  112  should implement. Driver or control signals  718  may be sent from the controller  702  to vibration source  112  via, for example, conductive element  614 . 
         [0041]    As shown in  FIG. 6B , controller  702  receives inputs from two different sources. First, controller  702  receives inputs from a user interface  704 . User interface  704  may include any set of buttons, switches, joysticks, controls or other interface that allows a user to enter information into the system. Second, controller  702  receives inputs from stored vibration data characteristics, or vibration profiles. Alternatively, vibration profiles may be stored directly in controller  702 . User interface  704  may be used by the surgeon to adjust the characteristics of the surgery being performed and/or to directly change the vibration profile being implemented by the vibration source. If user interface  704  is used to adjust the characteristics before a surgery, such characteristics may be used by the controller to select an initial vibration profile  716  to be used during surgery. 
         [0042]    However, if the surgeon recognizes a change in circumstances during the surgery, such as the intricacies of a patient&#39;s body, then the surgeon may choose to adjust the vibration profile during surgery. As noted, there is not one vibration profile that would maximize the effectiveness of the vibrating insertion tool in all surgical situations. Since certain specific vibration profiles help to maximize the effectiveness of the vibrations implemented by the insertion tool so as to minimize any trauma experienced by the recipient, the applicable vibration profile may change with a change in surgical circumstances. Accordingly, the vibration profiles are variable based on various factors. Therefore, the surgeon may recognize a change in circumstances, or surgical situation, such that a different vibration profile would be be more effective for those new circumstances. As noted, various factors/circumstances may change during surgery, such as the type and dimensions of insertion tool being used, the surgeon&#39;s grip on insertion tool, the geometry of the patient, surgical technique, environmental conditions in and around the patient, among others. Therefore, the user interface  704  may be used to adjust the characteristics during a surgery, such characteristics may be used by the controller to automatically implement a different, or adjusted, vibration profile  720  on the fly. For example, if the surgeon adjusts the type of surgery being performed, one aspect of the vibration profile, such as the amplitude or frequency of the vibration profile, may change to adjust for the change in surgery circumstances. The surgeon may also directly select a different vibration profile if the surgeon knows which vibration profile will be most effective for the new circumstances. After a new vibration profile has been adjusted/selected, the controller  702  will send new driver/control signals  718  to drive the vibration source  112  based on the adjusted vibration characteristics. 
         [0043]    For example, referring back to  FIG. 5 , the vibration profile used to yield insertion force data represented by plot  602 C may minimize the insertion forces applied to the recipient&#39;s cochlea structures in a certain set of circumstances. However, the vibration profile used to yield insertion force data represented by plot  602 A or  602 B may minimize the insertion forces applied to the recipient&#39;s cochlea structures in different surgical circumstances. 
         [0044]    The technology described and claimed herein is not to be limited in scope by the specific preferred embodiments herein disclosed, since these embodiments are intended as illustrations, and not limitations, of several aspects of the technology. Any equivalent embodiments are intended to be within the scope of this technology. Indeed, various modifications of the technology in addition to those shown and described herein will become apparent to those skilled in the art from the foregoing description. Such modifications are also intended to fall within the scope of the appended claims.