Transoral Palate-Sparing Nasopharyngectomy With the Flex® System: Preclinical Study

Objectives/Hypothesis: The nasopharynx remains one of the most challenging areas to surgically access given its deep location, narrow confines, and surrounding critical neurovascular anatomy. Various open and endoscopic approaches have been developed, all of which have been limited to some degree in their ability to bimanually instrument and visualize in this area. Study Design: Cadaveric dissection. Methods: Study using one fresh human cadaver. A novel, highly articulated endoscope with flexible instrumentation, the Flex System, was placed in the oral cavity and advanced around the soft palate into the nasopharynx to perform a nasopharyngectomy. Results: A complete nasopharyngectomy was accomplished with the Flex System without palatal incisions or extendedaccess approaches. Conclusions: The Flex System is a novel computer-assisted flexible endoscope with a highly articulated scope and flexible instruments that was successfully used to perform a nasopharyngectomy while avoiding any additional incisions. This system holds promise in minimally invasive skull base surgery.