title: Demonstration of nasopharyngeal surgery with a single port operator-controlled flexible endoscope system.
abstract: BACKGROUND
  Nasopharyngeal surgery is commonly performed with a rigid endoscope using a transnasal or transoral approach. Here, we demonstrate a flexible single port computer-assisted endoscopic system enabling easy transoral access to the nasopharynx.
  
  
  METHODS
  Transoral nasopharyngeal surgery was performed in human cadavers (n = 8) using the Flex System (Medrobotics, Raynham, MA). Learning curves were evaluated based on the time necessary for reaching the Eustachian tube. Mock surgical procedures were performed with compatible flexible instruments.
  
  
  RESULTS
  Nasopharyngeal surgery is feasible with the Flex System with a nontraumatic approach. The inbuilt HD digital camera enables high-quality visualization of the nasopharynx. The design of the flexible compatible tools adequately meets the requirements for surgical procedures in the nasopharynx.
  
  
  CONCLUSIONS
  The single port operator-controlled flexible endoscope system is a feasible way to approach the nasopharynx for surgical manipulation. Further clinical studies as well as development of supplemental tools are in progress.
authors.affiliation: Department of Otorhinolaryngology, University of Ulm, Ulm, Germany.
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Schuler
authors.affiliation: Department of Otorhinolaryngology, University of Ulm, Ulm, Germany.
authors.forename: Thomas K
authors.initials: TK
authors.lastname: Hoffmann
authors.affiliation: University of Pittsburgh Medical Center, Department of Otolaryngology, Pittsburgh, Pennsylvania.
authors.forename: Uma
authors.initials: U
authors.lastname: Duvvuri
authors.affiliation: Department of Otorhinolaryngology, University of Ulm, Ulm, Germany.
authors.forename: Nicole
authors.initials: N
authors.lastname: Rotter
authors.affiliation: Department of Otorhinolaryngology, University of Ulm, Ulm, Germany.
authors.forename: Jens
authors.initials: J
authors.lastname: Greve
authors.affiliation: Department of Otorhinolaryngology, University of Ulm, Ulm, Germany.
authors.forename: Marc O
authors.initials: MO
authors.lastname: Scheithauer
mesh_terms: D000328:Adult; D002102:Cadaver; D019723:Endoscopes; D004724:Endoscopy / Q000379:methods*; D004867:Equipment Design; D006801:Humans; D009305:Nasopharynx / Q000601:surgery*; D065287:Robotic Surgical Procedures / Q000379:methods; D012371:Robotics / Q000295:instrumentation*
keywords: camera; flexible endoscope; nasopharynx; retractor; transoral robotic surgery (TORS)