title: A single-port operator-controlled flexible endoscope system for endoscopic skull base surgery.
abstract: OBJECTIVE
  In a human cadaver study, a single-port operator-controlled flexible endoscope (Flex® System), facilitated with a high-definition camera and two accessory channels was tested for skull base surgery.
  
  
  METHODS
  Skull base surgery was performed on human cadavers (n=4) using the Flex® System. A modified surgical midfacial approach, performed by rigid standard tools, was used for access to the sinus system, the skull base, and the middle cranial fossa.
  
  
  RESULTS
  Endoscopic skull base visualization with the Flex® System is feasible. Surgical procedures performed included extended sinus surgery, anterior skull base approach, and visualization of the brain stem in the posterior cranial fossa. Important landmarks of the anterior skull base were visualized and manipulated by flexible compatible tools.
  
  
  CONCLUSIONS
  The Flex® System allows for manipulation of the anterior skull base and visualization of the posterior cranial fossa in a preclinical setting. Further studies as well as development of supplemental tools are in progress.
authors.affiliation: Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Ulm University Medical Center, Frauensteige 12, 89075, Ulm, Germany, patrick.schuler@uniklinik-ulm.de.
authors.forename: P J
authors.initials: PJ
authors.lastname: Schuler
authors.forename: M
authors.initials: M
authors.lastname: Scheithauer
authors.forename: N
authors.initials: N
authors.lastname: Rotter
authors.forename: J
authors.initials: J
authors.lastname: Veit
authors.forename: U
authors.initials: U
authors.lastname: Duvvuri
authors.forename: T K
authors.initials: TK
authors.lastname: Hoffmann
mesh_terms: D001933:Brain Stem / Q000473:pathology* / Q000601:surgery*; D002102:Cadaver; D055119:Elastic Modulus; D019723:Endoscopes; D004867:Equipment Design; D019544:Equipment Failure Analysis; D005240:Feasibility Studies; D006801:Humans; D008328:Man-Machine Systems; D015203:Reproducibility of Results; D065287:Robotic Surgical Procedures / Q000295:instrumentation*; D012680:Sensitivity and Specificity; D019291:Skull Base / Q000473:pathology* / Q000601:surgery*; D014584:User-Computer Interface