{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T14:51:29Z","timestamp":1786978289836,"version":"build-2736575974"},"reference-count":34,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2020,6,25]],"date-time":"2020-06-25T00:00:00Z","timestamp":1593043200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Laryngoscope"],"published-print":{"date-parts":[[2021,2]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Transoral surgery of the larynx with rigid instruments is not always possible. This may result in insufficient therapy or in an increased need for open surgery. For these patients, alternative surgical systems are needed. Here, we demonstrate a curved prototype for laryngeal surgery equipped with flexible instruments.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Design<\/jats:title>\n                    <jats:p>Pre\u2010clinical user study in an ex vivo porcine laryngeal model.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The prototype was built from established medical devices, namely a hyperangulated videolaryngoscope and modified flexible instruments as well as three\u2010dimensional printed parts. Feasibility of laryngeal manipulation was evaluated in a user study (n = 19) with a porcine ex vivo laryngeal model. Using three different visualization technologies, the participants performed various fine motor skills tasks and rated the usability of the system on a 5\u2010point Likert scale.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Exposure, accessibility, and manipulation of important laryngeal structures were always possible using the new prototype. The participants needed considerably less time (mean, 96.4\u2009seconds\u2009\u00b1\u20096.4\u2009seconds vs. 111.5\u2009seconds\u2009\u00b1\u20094.5\u2009seconds,\n                      <jats:italic>P<\/jats:italic>\n                      = .18), reported significantly better general impression (mean score 3.0 vs. 3.8,\n                      <jats:italic>P<\/jats:italic>\n                      = .041\n                      <jats:italic>)<\/jats:italic>\n                      and significantly lower user head and neck strain (2.6 vs. 1.7,\n                      <jats:italic>P<\/jats:italic>\n                      = .022) using a 40\u2010inch television screen as compared to a standard videolaryngoscope monitor.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      The results indicate that our curved prototype and large monitor visualization may provide a cost\u2010effective minimally invasive alternative for difficult laryngeal exposure. Its special advantages include avoiding the need for a straight line of sight and a simple and cost\u2010effective construction. The system could be further improved through advances in camera chip technology and smaller instruments.\n                      <jats:italic>Laryngoscope<\/jats:italic>\n                      , 131:E561\u2013E568, 2021\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/lary.28868","type":"journal-article","created":{"date-parts":[[2020,6,25]],"date-time":"2020-06-25T13:44:22Z","timestamp":1593092662000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Adding Flexible Instrumentation to a Curved Videolaryngoscope: A Novel Tool for Laryngeal Surgery"],"prefix":"10.1002","volume":"131","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3271-7682","authenticated-orcid":false,"given":"Leon R.","family":"Schild","sequence":"first","affiliation":[{"name":"Department of Otorhinolaryngology, Head and Neck Surgery Ulm University Medical Centre  Ulm 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Germany"},{"name":"Surgical Oncology Ulm, i2SOUL Consortium  Ulm Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0628-0608","authenticated-orcid":false,"given":"Jens","family":"Greve","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, Head and Neck Surgery Ulm University Medical Centre  Ulm Germany"},{"name":"Surgical Oncology Ulm, i2SOUL Consortium  Ulm Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lutz","family":"D\u00fcrselen","sequence":"additional","affiliation":[{"name":"Institute of Orthopaedic Research and Biomechanics Centre for Trauma Research Ulm, Ulm University Medical Centre  Ulm Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas K.","family":"Hoffmann","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, Head and Neck Surgery Ulm University Medical Centre  Ulm Germany"},{"name":"Surgical Oncology Ulm, i2SOUL Consortium  Ulm Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1065-8709","authenticated-orcid":false,"given":"Patrick J.","family":"Schuler","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, Head and Neck Surgery Ulm University Medical Centre  Ulm Germany"},{"name":"Surgical Oncology Ulm, i2SOUL Consortium  Ulm 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