title: Potential Advantages of a Single-Port, Operator-Controlled Flexible Endoscope System for Transoral Surgery of the Larynx.
abstract: BACKGROUND
  Transoral surgery of the larynx is commonly performed with a rigid laryngoscope, a microscope, and a laser. We investigated the potential utility of a flexible, single-port, robot-assisted and physician-controlled endoscopic system to enable easy, transoral surgical access to the larynx.
  
  
  METHODS
  Transoral laryngeal surgery was performed in human cadavers (n = 4) using the Flex System and compatible flexible instruments. Anatomical landmarks were identified, and mock surgical procedures were performed.
  
  
  RESULTS
  Standard laryngeal surgical procedures were completed successfully in a human cadaver model. The built-in HD digital camera enabled high-quality visualization of the larynx. Epiglottectomy, as well as posterior cordectomy, were performed by laser and radio-frequency resection. The flexible design of the compatible tools enabled a nontraumatic approach.
  
  
  CONCLUSIONS
  The Flex System has the potential to improve surgical access to the larynx, especially in patients with challenging anatomy. The associated flexible instruments enabled completion of surgical procedures in the larynx in a human cadaveric model. Further clinical studies, as well as the development of supplemental technology and tools, are recommended for future clinical applications.
authors.affiliation: Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Ulm University Medical Center, Ulm, Germany.
authors.forename: Daniel T
authors.initials: DT
authors.lastname: Friedrich
authors.affiliation: Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Ulm University Medical Center, Ulm, Germany.
authors.forename: Marc O
authors.initials: MO
authors.lastname: Scheithauer
authors.affiliation: Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Ulm University Medical Center, Ulm, Germany.
authors.forename: Jens
authors.initials: J
authors.lastname: Greve
authors.affiliation: University of Pittsburgh Medical Center, Department of Otolaryngology, Pittsburgh, PA, USA.
authors.forename: Uma
authors.initials: U
authors.lastname: Duvvuri
authors.affiliation: Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Ulm University Medical Center, Ulm, Germany.
authors.forename: Fabian
authors.initials: F
authors.lastname: Sommer
authors.affiliation: Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Ulm University Medical Center, Ulm, Germany.
authors.forename: Thomas K
authors.initials: TK
authors.lastname: Hoffmann
authors.affiliation: Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Ulm University Medical Center, Ulm, Germany patrick.schuler@uniklinik-ulm.de.
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Schuler
mesh_terms: D000328:Adult; D004825:Epiglottis / Q000601:surgery*; D004867:Equipment Design; D006801:Humans; D007828:Laryngoscopy / Q000379:methods*; D008953:Models, Anatomic; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods; D065287:Robotic Surgical Procedures / Q000379:methods*; D020535:Video-Assisted Surgery / Q000379:methods*
keywords: TLM; TORS; camera; flexible endoscope; larynx; robot; transoral laser microsurgery; transoral robotic surgery