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.
Design
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.
Conclusion
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.
Zusammenfassung
Ziel
Im Rahmen einer menschlichen Kadaverstudie wurde ein flexibles bedienergesteuertes Single-Port-Endoskopsystem für die endoskopische Schädelbasischirurgie (Flex®-System), das mit einer hochauflösenden Kamera und 2 Zusatzkanälen ausgestattet war, für die Schädelbasischirurgie getestet.
Studiendesign
Schädelbasisoperationen wurden an menschlichen Leichen (n = 4) mit dem Flex®-System durchgeführt. Ein modifizierter chirurgischer Zugang zum Mittelgesicht mit starren Standardinstrumenten diente dazu, die Sinus, die Schädelbasis und die mittlere Schädelgrube zu erreichen.
Ergebnisse
Die endoskopische Darstellung der Schädelbasis ist mit dem Flex®-System machbar. Zu den durchgeführten operativen Maßnahmen gehörten eine ausgedehnte Sinusoperation, der Zugang zur vorderen Schädelbasis und die Darstellung des Hirnstamms in der hinteren Schädelgrube. Wichtige Landmarken der vorderen Schädelbasis wurden dargestellt und hierzu geeignete flexible Instrumente eingesetzt.
Schlussfolgerung
Das Flex®-System ermöglicht in einem präklinischen Rahmen das Operieren an der vorderen Schädelbasis und die Darstellung der hinteren Schädelgrube. Derzeit wird an weiteren Studien sowie an der Entwicklung ergänzender Instrumente gearbeitet.
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Acknowledgments
Author contributions: PJS and MOS performed experiments; PJS, UD, and JV analyzed results; TKH and MOS designed the research; PJS, NR, and TKH wrote the article.
The cadaver study was funded by Medrobotics©, who also provided the flexible endoscope.
Compliance with ethical guidelines
Conflict of interest. P.J. Schuler, M. Scheithauer, N. Rotter, J. Veit, U. Duvvuri, and T.K. Hoffmann state that there are no conflicts of interest.
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Schuler, P., Scheithauer, M., Rotter, N. et al. A single-port operator-controlled flexible endoscope system for endoscopic skull base surgery. HNO 63, 189–194 (2015). https://doi.org/10.1007/s00106-014-2950-1
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DOI: https://doi.org/10.1007/s00106-014-2950-1