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, Hui-Ping

doi:10.1016/j.jtcvs.2010.11.011

« Previous Next »The Journal of Thoracic and Cardiovascular Surgery
Volume 141, Issue 5 , Pages 1223-1230, May 2011

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

Yun-Hen Liu, MD
- Laboratory Animal Center, Department of Surgery, Chang Gung Memorial Hospital, Linko, Chang Gung University, Taoyuan, Taiwan
Yen-Chu, PhD
- Laboratory Animal Center, Department of Surgery, Chang Gung Memorial Hospital, Linko, Chang Gung University, Taoyuan, Taiwan
Yi-Cheng Wu, MD
- Laboratory Animal Center, Department of Surgery, Chang Gung Memorial Hospital, Linko, Chang Gung University, Taoyuan, Taiwan
Chi-Ju Yeh, MD
- Department of Pathology, Chang Gung Memorial Hospital, Linko, Chang Gung University, Taoyuan, Taiwan
Hui-Wen Chang, MS
- Department of Pathology and Laboratory Medicine, Taipei Medical University, Taipei, Taiwan
Po-Jen Ko, MD
- Laboratory Animal Center, Department of Surgery, Chang Gung Memorial Hospital, Linko, Chang Gung University, Taoyuan, Taiwan
Hui-Ping Liu, MD
- Department of Surgery, Benq Medical Center, Nanjing, China
- Address for reprints: Hui-Ping Liu, MD, Department of Surgery, Benq Medical Center, Nanjing, China, 71 Hexi Ave, Jianye District, Nanjing, Jiangsu.

Received 29 July 2010; received in revised form 18 October 2010; accepted 4 November 2010. published online 31 January 2011.

Background

The present study aimed to evaluate the performance of transtracheal thoracic exploration and pericardial window creation in a canine survival model.

Methods

Transthoracic exploration was performed in 14 dogs. Under general anesthesia, after an incision in the right lateral wall of the middle–lower portion of the trachea was made, a 9-mm metal tube was advanced into the thoracic cavity. For thoracic cavity exploration and pericardial window creation, a flexible bronchoscope was introduced through the metal tube into the thoracic cavity. After thoracoscopy, a Dumon stent (Novatech, Grasse, France) was used to cover the tracheal incision site and facilitate healing. Animals were evaluated by endoscopy 1 and 2 weeks later. Animals were humanely killed, and necropsy was performed 2 weeks after the transtracheal natural orifice transluminal endoscopic surgery.

Results

Fourteen dogs underwent transtracheal thoracic exploration lasting for an average of 110 minutes (range, 80–150), with 3 perioperative deaths. At 2 weeks after pericardial window creation, endoscopy revealed normal healing of the tracheal incision sites in all 11 surviving animals. Necropsy on the 11 animals at 2 weeks showed 9 adhesions around the pericardial window and 5 adhesions around the tracheal incision region. No mediastinitis or abscesses could be identified.

Conclusions

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.

CTSNet classification: 15, 28

Abbreviations and Acronyms: CBC, complete blood count, CRP, C-reactive protein, NOTES, natural orifice transluminal endoscopic surgery, TTEP, transtracheal thoracic exploration