The endoscope manipulator system has the potential to be integrated into the operating workflow without extending the time for endoscope guidance. The surgeon will be able to use both hands for the manipulation of the instruments. Less frequent endoscope movements and instrument changes may be expected after technical modification.

Abstract-In this paper we present the kinematic design of the endoscope manipulator system (EMS), developed for endoand transnasal sinus surgery which enables the surgeon to operate bimanually. It is characterized by its miniaturized size of a human hand, its extreme lightweight construction and its special kinematics to serve the workspace in the paranasal sinuses. Using a parallel kinematics, it is possible to engineer a stiff and light system. The kinematic design allows bringing the pivot point close to the nostrils, without moving the whole system closer to the patient's head and to obstruct the passage for the surgeon's instruments. This system has been used during a surgical intervention for the first time. The surgeon's feedback is promising.

The manipulator MMS 2.0 was successfully used in the clinical setting for the first time. The tool offers great potential for middle ear surgery (e.g., tympanoplasty III, stapes surgery and cochlear implant insertion). The principal of telemanipulation (master-slave) could be transferred to middle ear surgery. However, numerous technical improvements are still required.

With a motorized navigation camera can be the interruption rate of LOS significantly improved at frontal and lateral skull base. The technical expenditure for installation of the NCA robot is little even during, for this reason there is the potential that this module can be established for the clinical practice.