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Volume 71, Issue 1, Pages 171-175 (January 2010)


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Online videoAuthor interview seriesFeasibility of endoscopic transesophageal thoracic sympathectomy (with video)

Brian G. Turner, MD, Denise W. Gee, MD, Sevdenur Cizginer, MD, Yusuf Konuk, MD, Cetin Karaca, MD, Field Willingham, MD, MPH, Mari Mino-Kenudson, MD, Christopher Morse, MD, David W. Rattner, MD, William R. Brugge, MD, FASGECorresponding Author Information

Received 20 February 2009; accepted 9 July 2009. published online 02 November 2009.

Background

Thoracoscopic sympathectomy is the preferred surgical treatment for patients with disabling palmar hyperhidrosis. Current methods require a transthoracic approach to permit ablation of the thoracic sympathetic chain.

Objective

To develop a minimally invasive, transesophageal endoscopic technique for a sympathectomy in a swine model.

Design

Nonsurvival animal study.

Setting

Animal trial at a tertiary care academic center.

Subjects

This study involved 8 healthy Yorkshire swine.

Interventions

After insertion of a double-channel gastroscope, a Duette Band mucosectomy device was used to create a small esophageal mucosal defect. A short, 5-cm submucosal tunnel was created by using the tip of the endoscope and biopsy forceps. Within the submucosal space, a needle-knife was used to incise the muscular esophageal wall and permit entry into the mediastinum and chest. The sympathetic chain was identified at the desired thoracic level and was ablated or transected. The animals were killed at the completion of the procedure.

Main Outcome Measurements

Feasibility of endoscopic transesophageal thoracic sympathectomy.

Results

The sympathetic chain was successfully ablated in 7 of 8 swine, as confirmed by gross surgical pathology and histology. In 1 swine, muscle fibers were inadvertently transected. On average, the procedure took 61.4±24.5minutes to gain access to the chest, whereas the sympathectomy was performed in less than 3minutes in all cases. One animal was killed immediately after sympathectomy, before the completion of the observation period, because of hemodynamic instability.

Limitations

Nonsurvival series, animal study.

Conclusions

Endoscopic transesophageal thoracic sympathectomy is technically feasible, simple, and can be performed in a porcine model.

Boston, Massachusetts, USA

Current affiliations: Gastrointestinal Unit (B.G.T., S.C., C.K., F.W., W.R.B.), Department of Surgery (D.W.G., Y.K., C.M., D.W.R.), Department of Pathology (M.M.-K.), Massachusetts General Hospital, Boston, Massachusetts, USA

Corresponding Author InformationReprint requests: William R. Brugge, MD, FASGE, Gastroenterology Unit, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114.

 DISCLOSURE: This project was funded by the Center for Integration of Medicine and Innovative Technology. Dr Brugge disclosed a consultant relationship with Boston Scientific. All other authors disclosed no other financial relationships relevant to this publication.

 The video from this article was presented at the 4th International NOSCAR Conference on NOTES, July [9-11], 2009, Boston, MA.

PII: S0016-5107(09)02233-0

doi:10.1016/j.gie.2009.07.016


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