Natural orifice transluminal endoscopic surgery: A transtracheal approach for the thoracic cavity in a live canine model

Liu, Yun-Hen; Yen-Chu,; Wu, Yi‐Cheng; Yeh, Chi-Ju; Chang, Hui‐Wen; Ko, Po‐Jen; Liu, Huiping

doi:10.1016/j.jtcvs.2010.11.011

Cited by 9 publications

(6 citation statements)

References 11 publications

(18 reference statements)

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“…Minimizing tissue trauma and subsequent stress response is a goal of surgery [ 42 ] and CRP is often included as an objective marker in studies investigating this response in dogs [ 37 , 42 , 43 , 45 ]. CRP has on several occasions been used in studies investigating new surgical procedures for the veterinary clinic [ 26 , 29 , 31 , 35 ], in studies using dogs as model for human disease [ 27 , 28 , 30 ], and in studies comparing different surgical procedures [ 32 , 34 ]. In the last group several studies have compared surgical trauma by comparing different surgical procedures in different tissues [ 9 , 33 ].…”

Section: Reviewmentioning

confidence: 99%

“…One study has, however, shown significant lower concentrations of CRP as a result of treatment with low doses of ketamine during and after surgery [ 40 ], as also demonstrated in humans [ 51 ]. Ketamine was included in the anesthetic protocols of 6 studies included in the review [ 22 , 27 , 28 , 32 , 34 , 41 ], and CRP concentrations in these studies could potentially be affected when compared to the remaining studies. However, other studies in human medicine have shown conflicting results [ 52 , 53 ] and the conclusions for dogs were all based on a single study affected by considerable risks of bias (Fig.…”

Section: Reviewmentioning

confidence: 99%

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C-reactive protein: quantitative marker of surgical trauma and post-surgical complications in dogs: a systematic review

2015

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C-reactive protein (CRP) is a major acute phase protein showing increasing serum concentrations in dogs with systemic inflammation following e.g., surgery, trauma, infections, or neoplasia. CRP is a useful diagnostic marker of systemic inflammation in dogs and automated assays have been validated for reliable measurements for routine diagnostic purposes. In the present study available evidence for the use of CRP as a marker of surgery related systemic inflammation in dogs was reviewed and assessed. Two main themes were in focus: (1) canine CRP as a potential marker of postsurgical infectious complications and (2) canine CRP as a marker of the degree of surgical trauma. As outlined in the review several studies suggest that CRP is a useful marker for both purposes. However, the evidence level is limited and studies in the field are all affected by considerable risks of bias. Thus, further studies are needed in order to confirm the assumptions from previous studies and increase the level of evidence for CRP as a useful marker for detecting inflammation after surgery in dogs.

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Section: Reviewmentioning

confidence: 99%

Section: Reviewmentioning

confidence: 99%

C-reactive protein: quantitative marker of surgical trauma and post-surgical complications in dogs: a systematic review

2015

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“…These procedures include subxiphoid pericardial window creation, coronary surgery, thymectomy, and pulmonary metastasectomy (10)(11)(12)(13)(14). We have used animal models to determine alternative approaches such as natural orifice transluminal surgery through transoral, transtracheal (15)(16)(17)(18), and transumbilical routes (19). However, most of these procedures are currently not feasible to be performed in humans.…”

Section: Introductionmentioning

confidence: 99%

Subxiphoid single-port video-assisted thoracoscopic surgery

et al. 2016

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Our results indicated that subxiphoid single-incision thoracoscopic pulmonary resection could be performed safely but under careful patient selection with modification of instruments. Moreover, having a previous single-port incision experience was crucial. Major limitations of this approach included more frequently encountered instrument fighting; interference of left-side procedure related to heartbeat and radical mediastinal lymph node (LN) dissection; and the ability to handle complex conditions, such as anthracotic LNs, diffuse adhesion, and major bleeding.

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“…The diaphragmatic incision was then sequentially dilated to 2.5 cm using a metallic tube, as previously described. 9 Two metallic tubes (10 mm and 15 mm) were then inserted into the thoracic cavity via the diaphragmatic incision and used as a working port for stapled lung wedge resection. After adequate exploration of the thoracic cavity with the bronchoscope via the 10-mm port, the stapler was gently applied to the targeted lung lobe (left upper lobe, n = 3; right upper lobe n = 3; right middle lobe, n = 3; right lower lobe, n = 2) via the 15-mm port.…”

Section: Methodsmentioning

confidence: 99%

Lung Resection Using Transumbilical Incision: An Animal Survival Study

Yin

Yen-Chu

et al. 2015

JSLS

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Introduction:Transumbilical single-port surgery is a potentially less invasive approach to many types of abdominal surgeries and offers better cosmetic outcomes than conventional 3-port laparoscopic surgery. It avoids the complication of intercostal neuralgia and may reduce the risk of pulmonary complications after video-assisted thoracic surgery. This study evaluated the feasibility of transumbilical lung wedge resection.Methods:Lung resection was performed in 11 beagle dogs weighing 5.9 to 8.5 kg. A 3-cm umbilical incision and one diaphragmatic incision were made, and an endoscopic stapler was used. The diaphragmatic incisions were repaired under video guidance using a V-Loc knotless suturing device (Covidien, Mansfield, Massachusetts). Animals were monitored daily for signs of postoperative infection. White blood cell count, C-reactive protein level, and IL-6 level were measured in all animals. Animals were euthanized 14 days after surgery and underwent necropsy evaluation.Results:Accurate lung resection was achieved in 10 of 11 animals during a median operative time of 98 minutes (range 60–165). In 1 animal, transumbilical lung resection was not possible and was converted to thoracotomy. All animals survived without major postoperative complications. At necropsy, evidence of uneventful healing of the stapled resection margin and diaphragmatic wound were found. There was no evidence of vital organ injury or intrathoracic infection.Conclusion:A transumbilical approach to thoracic cavity exploration and stapled lung resection is technically feasible. Primary suturing of the diaphragmatic incision is a simple and effective means of diaphragmatic wound closure. This may be an alternative to video-assisted thoracic surgery for the management of simple thoracic disease.

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Natural orifice transluminal endoscopic surgery: A transtracheal approach for the thoracic cavity in a live canine model

Abstract: Transtracheal thoracic exploration is technically feasible. Increasing surgical experience together with improvement in endoscopic techniques will further facilitate the development of natural orifice transluminal endoscopic surgery for thoracic diseases.

Cited by 9 publications

References 11 publications

C-reactive protein: quantitative marker of surgical trauma and post-surgical complications in dogs: a systematic review

C-reactive protein: quantitative marker of surgical trauma and post-surgical complications in dogs: a systematic review

Subxiphoid single-port video-assisted thoracoscopic surgery

Lung Resection Using Transumbilical Incision: An Animal Survival Study

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