Natural orifice transluminal endoscopic surgery (NOTES) in the mediastinum: long-term survival animal experiments in transesophageal access, including minor surgical procedures

Abstract

Transmural esophageal incision and endoscopic partial mediastinoscopy including therapeutic procedures on the heart or mediastinum proved feasible in long-term survival animal studies. Clip closure of the defect was effective, but did not close the esophageal muscle layer. Other means such as endoscopic suturing appear to be preferable.

Natural orifice transesophageal thoracoscopic surgery: A review of the current state

“…Using endoscopic ultrasound (EUS) to identify an appropriate esophageal entry site, Fritscher-Ravens et al [23] performed an esophageal incision using a needle-knife and exited directing into the mediastinum (Figure 1). EUS permitted identification of large vessels and positioning near the heart for planned procedures.…”

“…EUS has also been used to identify small mediastinal lymph nodes that could be targeted for sampling and complete removal [23] . In cases where fine needle aspirates do not provide sufficient information, the preserved lymph node architecture obtained with this technique could provide a more definitive pathologic sample.…”

“…To date, interventions in swine models have included lymph node biopsies and lymphadenectomy, pericardial fenestration, myocardial saline injections, pleural biopsy, and the creation of a pericardial window among others [21,23] . A current summary of experience with transesophageal access to the mediastinum and thoracic cavity is detailed in Tables 1-2.…”

“…Perhaps unexpectedly, these studies demonstrated good clinical outcomes and no evidence of large abscesses or mediastinitis. One group has experimented with endoscopic suturing devices for the closure of transesophageal entry sites [23] . While the endoscopic sutures successfully closed the mucosal defects in the esophagus, there were remaining defects in the esophageal muscular wall on necropsy.…”

“…Fritscher-Ravens et al [23] 2007 9 Yes 2 , n = 3 14, (n = 3) Needle-knife Mediastinoscopy, thoracoscopy, myocardial and left atrium saline injection, pericardial fenestration, lymphadenectomy Yes, n = 4 28, (n = 1) No, n = 2 42, (n = 3) Sumiyama et al [24] 2007 4 Yes 2 14 SEMF Mediastinoscopy Gee et al [21] 2008 4 Yes 1 8, (n = 2) m-SEMF Pleural biopsy, Mediastinoscopy, thoracoscopy 12, (n = 2) Sumiyama et al [34] 2008 5 Yes 2 7 SEMF Mediastinoscopy, thoracoscopy, pericardial window, epicardial ablation Willingham et al [22] Fritscher-Ravens et al [23] Prototype T-tag device (n = 6) Pericardial hematoma (acute animal) None 1 None EndoClip (n = 3) Sumiyama et al [24] SEMF Pleural injury resulting in death None None 25 (n = 1) Gee et al [21] m-SEMF + Endoclip (n = 2), m-SEMF only (n = 2)…”