Peroral esophageal segmentectomy and anastomosis with single transthoracic trocar: a step forward in thoracic NOTES

• Tipo: Artigo em Revista Científica Internacional
• Data: 2011

Autores

Rolanda, C (Autor) Outra; Silva, D (Autor) Outra; Branco, C (Autor) Outra; Moreira, I (Autor) Outra; Macedo G (Autor) FMUP; Correia Pinto, J (Autor) Outra

Revista

Título: Endoscopy

Vol. 43

Páginas: 14-20

ISSN: 0013-726X

Editora: Thieme

Indexação

ISI Web of Knowledge - 12 Citações

Scopus - 12 Citações

Outras Informações

ID Authenticus: P-002-YCP

DOI: 10.1055/s-0030-1256012

Abstract (EN): Background and study aims: A transesophageal natural orifice transluminal endoscopic surgery (NOTES) approach has been proposed for thoracic and mediastinal access. Similarly to transgastric surgery, serious limitations remain related to creating an esophagotomy and its safe closure. A hybrid approach in thoracic NOTES could work as an intermediate step before pure transesophageal NOTES. We assessed the benefit of hybrid thoracic NOTES for peroral segmental esophagectomy and subsequent complete esophageal anastomosis with a single transthoracic port. Methods: Two protocols were used to attempt esophago-esophageal anastomosis: ex vivo using a phantom model (n = 5), and in vivo after esophageal mobilization, and segmental esophagectomy achieved using either a gastroscope (flexible) (n = 5) or thoracoscope (rigid) instruments (n = 5). A forward-viewing double-channel endoscope and a transthoracic operative thoracoscope with a working channel were coordinated in order to create a complete single-layer, end-to-end esophageal anastomosis ex vivo as well as in vivo. Feasibility and anastomosis quality were evaluated by inside and outside assessment of: patency, the incorporation of mucosa in all stitches, and a leak test. Results: Anastomosis was achieved in all ex vivo experiments and thoracoscopically-led in vivo procedures. All anastomoses were patent, allowing distal passage of the endoscope, with mucosa incorporation. In in vivo experiments, a leak was detected in three animals and corrected with additional stitching. Conclusions: Peroral esophageal anastomosis with a single transthoracic trocar is feasible, which may represent a step forward in thoracic NOTES.

Idioma: Inglês

Tipo (Avaliação Docente): Científica

Nº de páginas: 7