This work presents the development of a parallel manipulator used for otological surgery from the perspective of co-design. Co-design refers to the simultaneous involvement of the end-users (surgeons), stakeholders (designers, ergonomic experts, manufacturers), and experts from the fields of optimization and mechanisms. The role of each member is discussed in detail and the interactions between the stakeholders are presented. Co-design facilitates a reduction in the parameter space considered during mechanism optimization, leading to a more efficient design process. Additionally, the co-design principles help avoid unforeseen errors and help in quicker adaptation of the proposed solution.