{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T04:57:17Z","timestamp":1792645037907,"version":"4.5.0"},"reference-count":21,"publisher":"Springer Science and Business Media LLC","issue":"8","license":[{"start":{"date-parts":[[2021,3,12]],"date-time":"2021-03-12T00:00:00Z","timestamp":1615507200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,3,12]],"date-time":"2021-03-12T00:00:00Z","timestamp":1615507200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Surg Endosc"],"published-print":{"date-parts":[[2021,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>We investigated a novel minimally invasive surgical platform for use in the oropharynx, hypopharynx, and larynx for single-port transoral surgery used in concert with standard transoral laryngeal and pharyngeal instrumentation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The preclinical investigational device by Fortimedix Surgical B.V. (Netherlands) features two channels for manually controlled flexible articulating surgical instruments. A third central channel accepts both rigid and flexible endoscopes. The system is coupled to a standard laryngoscope for transoral access. In three cadaver models, we evaluated the surgical capabilities using wristed grasping instruments, microlaryngeal scissors, monopolar cautery, and a laser fiber sheath. Procedures were performed within the oropharynx, supraglottis, glottis, subglottis, and hypopharynx.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Within the oropharynx, we found adequate strength, range of motion, and dexterity to perform lateral oropharyngectomy and tongue base resection. Within the larynx, visualization was achieved with a variety of instruments including a flexible, 0\u00b0 and 30\u00b0 rigid endoscope. The glottis, supraglottis, pyriform sinuses, post-cricoid space, and esophageal inlet were readily accessible. Visualization and manipulation of grasping, laser, and monopolar cautery instruments were also possible within the subglottis. Instrument reach and accuracy facilitated completion of a delicate micro-flap on the true vocal fold. Other procedures included vocal fold resection, cricopharyngeal myotomy, and resection of subglottic mucosa.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>From this initial proof of concept experience with this novel platform, we found a wide range of procedures within the oropharynx, larynx, and hypopharynx to be feasible. Further work is needed to evaluate its applicability to the clinical setting. The ability of this platform to be used with conventional instrumentation may provide an opportunity for complex transoral surgery to be performed in a facile manner at greatly reduced cost.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00464-021-08420-2","type":"journal-article","created":{"date-parts":[[2021,3,12]],"date-time":"2021-03-12T20:12:53Z","timestamp":1615579973000},"page":"4857-4864","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Preclinical experience with a novel single-port platform for transoral surgery"],"prefix":"10.1007","volume":"35","author":[{"given":"Emily K.","family":"Funk","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philip","family":"Weissbrod","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Santiago","family":"Horgan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryan K.","family":"Orosco","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph A.","family":"Califano","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,3,12]]},"reference":[{"key":"8420_CR1","doi-asserted-by":"publisher","first-page":"1944","DOI":"10.1056\/NEJMoa065497","volume":"356","author":"G D'Souza","year":"2007","unstructured":"D\u2019Souza G, Kreimer AR, Viscidi R et al (2007) Case-control study of human papillomavirus and oropharyngeal cancer. N Engl J Med 356:1944\u20131956","journal-title":"N Engl J Med"},{"key":"8420_CR2","doi-asserted-by":"publisher","first-page":"709","DOI":"10.1093\/jnci\/92.9.709","volume":"92","author":"ML Gillison","year":"2000","unstructured":"Gillison ML, Koch WM, Capone RB et al (2000) Evidence for a causal association between human papillomavirus and a subset of head and neck cancers. J Natl Cancer Inst 92:709\u2013720","journal-title":"J Natl Cancer Inst"},{"key":"8420_CR3","doi-asserted-by":"publisher","first-page":"573","DOI":"10.1002\/hed.21500","volume":"33","author":"MA Cohen","year":"2011","unstructured":"Cohen MA, Weinstein GS, O\u2019Malley BW Jr et al (2011) Transoral robotic surgery and human papillomavirus status: Oncologic results. Head Neck 33:573\u2013580","journal-title":"Head Neck"},{"key":"8420_CR4","first-page":"135","volume":"39","author":"W Steiner","year":"1988","unstructured":"Steiner W (1988) Experience in endoscopic laser surgery of malignant tumours of the upper aero-digestive tract. Adv Otorhinolaryngol 39:135\u2013144","journal-title":"Adv Otorhinolaryngol"},{"key":"8420_CR5","doi-asserted-by":"publisher","first-page":"490","DOI":"10.1016\/0002-9610(78)90267-2","volume":"136","author":"CW Vaughan","year":"1978","unstructured":"Vaughan CW, Strong MS, Jako GJ (1978) Laryngeal carcinoma: transoral treatment utilizing the CO2 laser. Am J Surg 136:490\u2013493","journal-title":"Am J Surg"},{"issue":"3","key":"8420_CR6","doi-asserted-by":"publisher","first-page":"77","DOI":"10.3390\/medicines6030077","volume":"6","author":"CM Chiesa-Estomba","year":"2019","unstructured":"Chiesa-Estomba CM, Gonzalez-Garcia JA, Larruscain E et al (2019) CO2 Transoral Laser Microsurgery in Benign, Premalignant and Malignant (Tis, T1, T2) Lesion of the Glottis A Literature Review. Medicines (Basel) 6(3):77","journal-title":"Medicines (Basel)"},{"key":"8420_CR7","doi-asserted-by":"publisher","first-page":"1701","DOI":"10.1002\/lary.23294","volume":"122","author":"GS Weinstein","year":"2012","unstructured":"Weinstein GS, O\u2019Malley BW Jr, Magnuson JS et al (2012) Transoral robotic surgery: a multicenter study to assess feasibility, safety, and surgical margins. Laryngoscope 122:1701\u20131707","journal-title":"Laryngoscope"},{"key":"8420_CR8","doi-asserted-by":"crossref","first-page":"2485","DOI":"10.1002\/lary.23994","volume":"123","author":"B Lallemant","year":"2013","unstructured":"Lallemant B, Chambon G, Garrel R et al (2013) Transoral robotic surgery for the treatment of T1\u2013T2 carcinoma of the larynx: preliminary study. Laryngoscope 123:2485\u20132490","journal-title":"Laryngoscope"},{"key":"8420_CR9","doi-asserted-by":"publisher","first-page":"361","DOI":"10.1089\/lap.2008.0320","volume":"19","author":"YM Park","year":"2009","unstructured":"Park YM, Lee WJ, Lee JG et al (2009) Transoral robotic surgery (TORS) in laryngeal and hypopharyngeal cancer. J Laparoendosc Adv Surg Tech A 19:361\u2013368","journal-title":"J Laparoendosc Adv Surg Tech A"},{"key":"8420_CR10","doi-asserted-by":"publisher","first-page":"835","DOI":"10.1001\/jama.2018.9219","volume":"320","author":"CP Childers","year":"2018","unstructured":"Childers CP, Maggard-Gibbons M (2018) Estimation of the Acquisition and Operating Costs for Robotic Surgery. JAMA 320:835\u2013836","journal-title":"JAMA"},{"key":"8420_CR11","doi-asserted-by":"publisher","first-page":"126","DOI":"10.1097\/MOO.0b013e32832924f5","volume":"17","author":"GS Weinstein","year":"2009","unstructured":"Weinstein GS, O\u2019Malley BW Jr, Desai SC et al (2009) Transoral robotic surgery: does the ends justify the means? Curr Opin Otolaryngol Head Neck Surg 17:126\u2013131","journal-title":"Curr Opin Otolaryngol Head Neck Surg"},{"key":"8420_CR12","doi-asserted-by":"publisher","first-page":"165","DOI":"10.1002\/lary.24358","volume":"124","author":"JD Richmon","year":"2014","unstructured":"Richmon JD, Quon H, Gourin CG (2014) The effect of transoral robotic surgery on short-term outcomes and cost of care after oropharyngeal cancer surgery. Laryngoscope 124:165\u2013171","journal-title":"Laryngoscope"},{"key":"8420_CR13","doi-asserted-by":"publisher","first-page":"2825","DOI":"10.1007\/s00405-014-3056-9","volume":"271","author":"M Dombr\u00e9e","year":"2014","unstructured":"Dombr\u00e9e M, Crott R, Lawson G et al (2014) Cost comparison of open approach, transoral laser microsurgery and transoral robotic surgery for partial and total laryngectomies. Eur Arch Otorhinolaryngol 271:2825\u20132834","journal-title":"Eur Arch Otorhinolaryngol"},{"key":"8420_CR14","doi-asserted-by":"publisher","first-page":"953","DOI":"10.1007\/s00464-015-4319-2","volume":"30","author":"M Berducci","year":"2016","unstructured":"Berducci M, Fuchs HF, Omelanczuk P et al (2016) Phase II clinical experience and long-term follow-up using the next-generation single-incision platform FMX314. Surg Endosc 30:953\u2013960","journal-title":"Surg Endosc"},{"key":"8420_CR15","doi-asserted-by":"publisher","first-page":"1250","DOI":"10.1007\/s00464-014-3779-0","volume":"29","author":"RC Broderick","year":"2015","unstructured":"Broderick RC, Omelanczuk P, Harnsberger CR et al (2015) Laparoscopic cholecystectomy using a novel single-incision surgical platform through a standard 15mm trocar: initial experience and technical details. Surg Endosc 29:1250\u20131256","journal-title":"Surg Endosc"},{"key":"8420_CR16","doi-asserted-by":"publisher","first-page":"391","DOI":"10.1002\/lary.26358","volume":"127","author":"S Lang","year":"2017","unstructured":"Lang S, Mattheis S, Hasskamp P et al (2017) A european multicenter study evaluating the flex robotic system in transoral robotic surgery. Laryngoscope 127:391\u2013395","journal-title":"Laryngoscope"},{"key":"8420_CR17","doi-asserted-by":"publisher","first-page":"471","DOI":"10.1002\/hed.24611","volume":"39","author":"S Mattheis","year":"2017","unstructured":"Mattheis S, Hasskamp P, Holtmann L et al (2017) Flex Robotic System in transoral robotic surgery: The first 40 patients. Head Neck 39:471\u2013475","journal-title":"Head Neck"},{"issue":"11","key":"8420_CR18","doi-asserted-by":"publisher","first-page":"1027","DOI":"10.1001\/jamaoto.2019.2654","volume":"145","author":"FC Holsinger","year":"2019","unstructured":"Holsinger FC, Magnuson JS, Weinstein GS et al (2019) A Next-Generation Single-Port Robotic Surgical System for Transoral Robotic Surgery: Results From Prospective Nonrandomized Clinical Trials. JAMA Otolaryngol Head Neck Surg 145(11):1027","journal-title":"JAMA Otolaryngol Head Neck Surg"},{"key":"8420_CR19","doi-asserted-by":"publisher","first-page":"101","DOI":"10.1016\/j.oraloncology.2019.05.018","volume":"94","author":"JYK Chan","year":"2019","unstructured":"Chan JYK, Tsang RK, Holsinger FC et al (2019) Prospective clinical trial to evaluate safety and feasibility of using a single port flexible robotic system for transoral head and neck surgery. Oral Oncol 94:101\u2013105","journal-title":"Oral Oncol"},{"key":"8420_CR20","doi-asserted-by":"publisher","first-page":"78","DOI":"10.1002\/lary.26649","volume":"128","author":"MM Chen","year":"2018","unstructured":"Chen MM, Orosco RK, Lim GC et al (2018) Improved transoral dissection of the tongue base with a next-generation robotic surgical system. Laryngoscope 128:78\u201383","journal-title":"Laryngoscope"},{"key":"8420_CR21","doi-asserted-by":"publisher","first-page":"419","DOI":"10.1016\/j.anorl.2017.06.002","volume":"134","author":"F Rubin","year":"2017","unstructured":"Rubin F, Laccourreye O, Weinstein G et al (2017) Transoral lateral oropharyngectomy. Eur Ann Otorhinolaryngol Head Neck Dis 134:419\u2013422","journal-title":"Eur Ann Otorhinolaryngol Head Neck Dis"}],"container-title":["Surgical Endoscopy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00464-021-08420-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00464-021-08420-2\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00464-021-08420-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,23]],"date-time":"2023-10-23T02:19:20Z","timestamp":1698027560000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00464-021-08420-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,3,12]]},"references-count":21,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2021,8]]}},"alternative-id":["8420"],"URL":"https:\/\/doi.org\/10.1007\/s00464-021-08420-2","relation":{},"ISSN":["0930-2794","1432-2218"],"issn-type":[{"value":"0930-2794","type":"print"},{"value":"1432-2218","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,3,12]]},"assertion":[{"value":"22 October 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"23 February 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"12 March 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"Dr. Horgan is a consultant for Fortimedix. Drs. Funk, Weissbrod, Orosco and Califano have no conflicts of interest or financial ties to disclose.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Disclosures"}}]}}