The aim of the present study was to describe the use of the endoscopic-assisted cochlear implantation in cases with an unsuccessful standard surgical technique because of not achieving adequate exposure to the round window (RW). Three patients with a bilateral profound hearing loss were operated using an endoscopic-assisted cochlear implant procedure at our tertiary university referral center between 2012 and 2014. In all of the patients, a retroauricular "c" shaped incision was performed and a subperiosteal pocket was created. Standard cortical mastoidectomy and posterior tympanotomy were accomplished using a otomicroscope. However, RW and promontory could not be seen using this approach. The tympanomeatal flap was elevated and the middle ear cavity was entered A rigid 0 degree endoscope (2.7 mm wide, 18 cm in length) (Karl Storz company, Tuttlingen, Germany) and a connected HD camera system (Karl Storz Company, Tuttlingen, Germany) were used to expose RW through posterior tympanotomy, and a drill was passed through the external ear canal. The RW niche was removed using a diamond burr under endoscopic view; the endoscope was placed through the external ear canal, and electrodes were transferred through posterior tympanotomy. The electrodes were fully inserted under the endoscopic view in all cases. Endoscopic-assisted cochlear implantation may be a safe alternative surgical technique in cases where surgeons are not able to visualize RW and promontory using a microscope.