Natural orifice transesophageal mediastinoscopy and thoracoscopy

DSpace/Manakin Repository

Natural orifice transesophageal mediastinoscopy and thoracoscopy

Citable link to this page

 

 
Title: Natural orifice transesophageal mediastinoscopy and thoracoscopy
Author: Willingham, F. F.; Gee, Denise W.; Lauwers, Gregory Y.; Brugge, William Robert; Rattner, David William

Note: Order does not necessarily reflect citation order of authors.

Citation: Willingham, F. F., D. W. Gee, G. Y. Lauwers, W. R. Brugge, and D. W. Rattner. 2007. “Natural Orifice Transesophageal Mediastinoscopy and Thoracoscopy.” Surgical Endoscopy 22 (4) (November 20): 1042–1047. doi:10.1007/s00464-007-9668-z.
Access Status: Full text of the requested work is not available in DASH at this time (“dark deposit”). For more information on dark deposits, see our FAQ.
Full Text & Related Files:
Abstract: Background: Thoracoscopy and mediastinoscopy are common procedures with painful incisions and prominent scars. A natural orifice transesophageal endoscopic surgical (NOTES) approach could reduce pain, eliminate intercostal neuralgia, provide access to the posterior mediastinal compartment, and improve cosmesis. In addition NOTES esophageal access routes also have the potential to replace conventional thoracoscopic approaches for medial or hilar lesions. Methods: Five healthy Yorkshire swine underwent nonsurvival natural orifice transesophageal mediastinoscopy and thoracoscopy under general anesthesia. An 8- to 9.8-mm video endoscope was introduced into the esophagus, and a 10-cm submucosal tunnel was created with blunt dissection. The endoscope then was passed through the muscular layers of the esophagus into the mediastinal space. The mediastinal compartment, pleura, lung, mediastinal lymph nodes, thoracic duct, vagus nerves, and exterior surface of the esophagus were identified. Mediastinal lymph node resection was easily accomplished. For thoracoscopy, a small incision was created through the pleura, and the endoscope was introduced into the thoracic cavity. The lung, chest wall, pleura, pericardium, and diaphragmatic surface were identified. Pleural biopsies were obtained with endoscopic forceps. The endoscope was withdrawn and the procedure terminated. Results: Mediastinal and thoracic structures could be identified without difficulty via a transesophageal approach. Lymph node resection was easily accomplished. Pleural biopsy under direct visualization was feasible. Selective mainstem bronchus intubation and collapse of the ipsilateral lung facilitated thoracoscopy. In one animal, an inadvertent 4-mm lung incision resulted in a pneumothorax. This was decompressed with a small venting intercostal incision, and the remainder of the procedure was completed without difficulty. Conclusions: Transesophageal endoscopic mediastinoscopy, lymph node resection, thoracoscopy, and pleural biopsy are feasible and provide excellent visualization of mediastinal and intrathoracic structures. Survival studies will be needed to confirm the safety of this approach.
Published Version: doi:10.1007/s00464-007-9668-z
Citable link to this page: http://nrs.harvard.edu/urn-3:HUL.InstRepos:35140971
Downloads of this work:

Show full Dublin Core record

This item appears in the following Collection(s)

 
 

Search DASH


Advanced Search
 
 

Submitters