Feasibility of the transtracheal approach for the thoracic cavity in a large animal model

Abstract

The transtracheal approach to the thoracic cavity is technically feasible in both porcine and canine models (4/12 animals died). The canine model is perhaps more suitable than the porcine model for the study of the transtracheal approach to the thoracic cavity.

Comparison of hemodynamic and inflammatory changes between transoral and transthoracic thoracoscopic surgery

“…Our group previously described the utilization of transtracheal thoracoscopy in 12 dogs; we encountered 3 cases of tension pneumothorax due to inadvertent injury to the lung during creation of a tracheal access site [20]. Recently, we have made significant progress in using a transoral route for surgical lung biopsy and pericardial window creation, without major intraoperative or postoperative complications [10]- [13]. Our findings suggest that a transoral approach can be used as a novel platform for studies of NOTES for intrathoracic surgery.…”

“…The feasibility of NOTES thoracoscopy has been demonstrated in various access methods (transvesical, transesophageal, transtracheal, and transoral) in porcine and canine models [8]- [10]. However, there have been no large, randomized, controlled trials of NOTES in thoracic surgery.…”

Endoscopic Closure of a Tracheal Access Site Using BioGlue after Transtracheal Thoracoscopy in a Nonsurvival Canine Model

“…Our team also has successfully performed multiple transtracheal thoracic procedures (i.e. thoracic explorations, surgical lung biopsies, and creation of pericardial windows) and has found that one of the most critical issues preventing the advancement of NOTES is the ability to ensure secure closure of visceral incisions [16,17] (table 2). …”

“…Recently, we demonstrated that a silicone stent placed over the tracheal access site in the thoracic cavity facilitates complete wound healing [4,5,16]. However, it is difficult to determine the accurate size of the stent to be used.…”

“…One concern with the NOTES approach to the peritoneal or thoracic cavity is the risk of injuring a vital organ during wound creation [16,20]. To minimize the risk of mediastinal and lung injury, we marked the custom-designed metallic knife and tube before use, and ensured that the puncture entry of this knife did not exceed a predetermined safe length (approx.…”