Skip to main content
SpringerLink
Log in

Transoral endoscopic surgery versus conventional thoracoscopic surgery for thoracic intervention: safety and efficacy in a canine survival model

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Purpose

Transoral endoscopic surgery has been shown to be feasible and safe in both humans and animal models. The purpose of this study was to evaluate the safety and efficacy of transoral and conventional thoracoscopy for thoracic exploration, surgical lung biopsy, and pericardial window creation.

Methods

The animals (n = 20) were randomly assigned to the transoral endoscopic approach group (n = 10) or conventional thoracoscopic approach group (n = 10). Transoral thoracoscopy was performed with a flexible bronchoscope via an incision over the vestibulum oris. In conventional thoracoscopy, access to the thoracic cavity was obtained through a thoracic incision. Surgical outcomes (body weight, operating time, operative complications, and time to resumption of normal diet), physiologic parameters (respiratory rate, body temperature), inflammatory parameters [white blood cell (WBC) counts and C-reactive protein (CRP)], and pulmonary parameters (arterial blood gases) were compared for both procedures.

Results

The surgical lung biopsy and pericardial window creation were successfully performed in all animals except one animal in the transoral group. There was no significant difference in operating times between the groups. The increase in WBC in the transoral thoracoscopy group was significantly smaller on postoperative day 1 than in the conventional thoracoscopy group (p = 0.0029). The transoral group had an earlier return to preoperative body temperature (p = 0.041) and respiratory rate (p = 0.045) on day 7. With respect to pulmonary parameters, there was no significant difference in blood pH, pCO2, or PaCO2 between the transoral and transthoracic groups. All animals survived without complications 14 days after surgery.

Conclusions

This study demonstrated that the transoral approach was comparable to conventional thoracoscopic surgery for lung biopsy and pericardial window creation in terms of safety and efficacy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Kalloo AN, Singh VK, Jagannath SB et al (2004) Flexible transgastric peritoneoscopy: a novel approach to diagnostic and therapeutic interventions in the peritoneal cavity. Gastrointest Endosc 60:114–117

    Article  PubMed  Google Scholar 

  2. Chukwumah C, Zorron R, Marks JM et al (2010) Current status of natural orifice translumenal endoscopic surgery (NOTES). Curr Probl Surg 47:630–668

    Article  PubMed  Google Scholar 

  3. Lehmann KS, Ritz JP, Wibmer A et al (2010) The German registry for natural orifice translumenal endoscopic surgery: report of the first 551 patients. Ann Surg 252:263–270

    Article  PubMed  Google Scholar 

  4. Ko PJ, Chu Y, Wu YC et al (2012) Feasibility of endoscopic transoral thoracic surgical lung biopsy and pericardial window creation. J Surg Res 175:207–214

    Article  PubMed  Google Scholar 

  5. Liu YH, Chu Y, Wu YC et al (2011) Single-dose antimicrobial prophylaxis in transoral surgical lung biopsy: a preliminary experience. Surg Endosc 25:3912–3917

    Article  PubMed  Google Scholar 

  6. Shields Thomas (2004) General thoracic surgery. Lippincott Williams & Wilkins, Philadelphia, p 524

    Google Scholar 

  7. Lima E, Henriques-Coelho T, Rolanda C et al (2007) Transvesical thoracoscopy: a natural orifice translumenal endoscopic approach for thoracic surgery. Surg Endosc 21:854

    Article  PubMed  Google Scholar 

  8. De Palma GD, Siciliano S, Addeo P et al (2010) A NOTES approach for thoracic surgery: transgastric thoracoscopy via a diaphragmatic incision in a survival porcine model. Minerva Chir 65:11

    PubMed  Google Scholar 

  9. Willingham FF, Gee DW, Lauwers GY et al (2008) Natural orifice transesophageal mediastinoscopy and thoracoscopy. Surg Endosc 22:1042–1047

    Article  PubMed  CAS  Google Scholar 

  10. Liu YH, Chu Y, Liu CY et al (2011) Feasibility of the transtracheal approach for the thoracic cavity in a large animal model. Surg Endosc 25:1652–1658

    Article  PubMed  Google Scholar 

  11. Sumiyama K, Gostout CJ, Rajan E et al (2007) Transesophageal mediastinoscopy by submucosal endoscopy with mucosal flap safety valve technique. Gastrointest Endosc 65:679–683

    Article  PubMed  Google Scholar 

  12. Sumiyama K, Gostout CJ, Rajan E et al (2008) Pilot study of transesophageal endoscopic epicardial coagulation by submucosal endoscopy with the mucosal flap safety valve technique (with videos). Gastrointest Endosc 67:497–501

    Article  PubMed  Google Scholar 

  13. von Delius S, Wilhelm D, Feussner H et al (2010) Natural orifice transluminal endoscopic surgery: cardiopulmonary safety of transesophageal mediastinoscopy. Endoscopy 42:405–412

    Article  Google Scholar 

  14. Liu YH, Yen-Chu WuYC et al (2011) Natural orifice transluminal endoscopic surgery: a transtracheal approach for the thoracic cavity in a live canine model. J Thorac Cardiovasc Surg 141:1223–1230

    Article  PubMed  Google Scholar 

  15. Narula VK, Hazey JW, Renton DB et al (2008) Transgastric instrumentation and bacterial contamination of the peritoneal cavity. Surg Endosc 22:605–611

    Article  PubMed  Google Scholar 

  16. Lomanto D, Chua HC, Myat MM et al (2009) Microbiological contamination during transgastric and transvaginal endoscopic techniques. J Laparoendosc Adv Surg Tech A 19:465–469

    Article  PubMed  Google Scholar 

  17. Giday SA, Dray X, Magno P et al (2010) Infection during natural orifice transluminal endoscopic surgery: a randomized, controlled study in a live porcine model. Gastrointest Endosc 71:812–816

    Article  PubMed  Google Scholar 

  18. Hong KH, Yang YS (2008) Surgical results of the intraoral removal of the submandibular gland. Otolaryngol Head Neck Surg 139:530–534

    Article  PubMed  Google Scholar 

  19. von Renteln D, Vassiliou MC, Rothstein RI (2009) Randomized controlled trial comparing endoscopic clips and over-the-scope clips for closure of natural orifice transluminal endoscopic surgery gastrotomies. Endoscopy 41:1056–1061

    Article  Google Scholar 

  20. Voermans RP, Worm AM, van Berge Henegouwen MI et al (2008) In vitro comparison and evaluation of seven gastric closure modalities for natural orifice transluminal endoscopic surgery (NOTES). Endoscopy 40:595–601

    Article  PubMed  CAS  Google Scholar 

  21. Song S, Itawi EA, Saber AA (2009) Natural orifice translumenal endoscopic surgery (NOTES). J Invest Surg 22:214–217

    Article  PubMed  Google Scholar 

  22. Stammberger U, Steinacher C, Hillinger S et al (2000) Early and long-term complaints following video-assisted thoracoscopic surgery: evaluation in 173 patients. Eur J Cardiothorac Surg 18:7–11

    Article  PubMed  CAS  Google Scholar 

  23. Hutter J, Reich-Weinberger S, Hitzl W et al (2007) Sequels 10 years after thoracoscopic procedures for benign disease. Eur J Cardiothorac Surg 32:409–411

    Article  PubMed  Google Scholar 

  24. Passlick B, Born C, Sienel W et al (2001) Incidence of chronic pain after minimal-invasive surgery for spontaneous pneumothorax. Eur J Cardiothorac Surg 19:355–358

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

The authors thank the National Science Council of the Republic of China, Taiwan, for financially supporting this research under contract numbers NSC 100-2314-B-182A-052 and NSC 101-2314-B-182A-091-MY2, and the Chang-Gung Memorial Hospital under contract numbers CMRPG 3A0371, 3B0101, 391913.

Disclosures

Chien-Ying Liu, Yen-Chu, Yi-Cheng Wu, Hsu-Chia Yuan, Po-Jen Ko, Yun-Hen Liu, and Hui-Ping Liu have no conflicts of interest or financial ties to disclose.

Author information

Authors and Affiliations

  1. Department of Thoracic Medicine, Chang Gung University, 5, Fushing Street, Gueishan Shiang, Taoyuan, 333, Taiwan, ROC

    Chien-Ying Liu

  2. Laboratory Animal Center, Department of Surgery, Chang Gung Memorial Hospital at linko, Chang Gung University, 5, Fushing Street, Gueishan Shiang, Taoyuan, 333, Taiwan, ROC

    Yen Chu, Yi-Cheng Wu, Hsu-Chia Yuan, Po-Jen Ko & Yun-Hen Liu

  3. Department of Surgery, Benq Medical Center, 71 Hexi Avenue, Jianye District, Nanjing, China

    Hui-Ping Liu

Authors
  1. Chien-Ying Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yen Chu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yi-Cheng Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hsu-Chia Yuan
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Po-Jen Ko
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Yun-Hen Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Hui-Ping Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding authors

Correspondence to Po-Jen Ko or Yun-Hen Liu.

Additional information

Chien-Ying Liu, Yen-Chu contributed equally to this work.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Liu, CY., Chu, Y., Wu, YC. et al. Transoral endoscopic surgery versus conventional thoracoscopic surgery for thoracic intervention: safety and efficacy in a canine survival model. Surg Endosc 27, 2428–2435 (2013). https://doi.org/10.1007/s00464-012-2753-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-012-2753-y

Keywords

Search

Navigation