Background
Natural orifice transluminal endoscopic surgery (NOTES) mediastinoscopy (MED) through
the esophagus has proved to be feasible in the animal model. However, injury of the
adjacent pleura and pneumothorax has been reported as a frequent adverse event when
using a blind access.
Objective
To assess the utility and safety of a CT-based image registration system (IRS) for
navigation in the mediastinum.
Design
Prospective, randomized, controlled trial in 30 Yorkshire pigs. Thirty-minute MEDs
were performed: 15 MEDs were performed with IRS guidance (MED-IRS), and 15 MEDs were
performed with a blind access.
Setting
Animal research laboratory.
Interventions
In both groups, the mediastinum was accessed through a 10-cm submucosal tunnel in
the esophageal wall. Timed exploration was performed with identification of 8 mediastinal
structures.
Main Outcome Measurements
Technical feasibility, adverse events, and the number of mediastinal structures identified.
Results
Thirty animals weighing 31.5 ± 3.5 kg were included in this study. MED was not possible
in 2 animals in the “MED with blind access” group but was possible in all MEDs performed
with IRS. The mean number of identified organs was slightly higher in “with IRS-MED”
(6.13 ± 1.3) than with MED with blind access (4.7 ± 2.3; P = .066). Moreover, the right atrium and vena cava were identified in more cases with
IRS-MED than in MED with blind access (13 vs 3 and 15 vs 11, P = .000 and P = .03, respectively). There were 3 (23%) adverse events with IRS-MED and 4 (27%)
with “MED with blind access” (P = not significant), with pneumothorax being the most frequent (2 and 3, respectively).
Limitations
Nonsurvival animal study.
Conclusions
This study demonstrates that the IRS system appears feasible in natural orifice transluminal
endoscopic surgery MED and suggests that IRS guidance might be useful for selected
procedures.
Abbreviations:
3D (3-dimensional), IRS (image registration system), MED (mediastinoscopy), NOTES (natural orifice transluminal endoscopic surgery)To read this article in full you will need to make a payment
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Article info
Publication history
Accepted:
September 7,
2012
Received:
May 8,
2012
Footnotes
DISCLOSURE: All authors disclosed no financial relationships relevant to this publication. This research project was supported by a grant from the Ministerio de Ciencia e Innovación (SAF2010-15635). Dr Córdova was supported by the Instituto Nacional de Salud Carlos III. Dr San José Estepar was supported by NIH grant K25 HL104085. Dr Vosburgh was supported by the Center for Integration of Medicine and Innovative Technology and the National Center for Image Guided Therapy, NIH grant P41 RR019703.
Identification
Copyright
© 2013 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.
