Natural orifice transluminal endoscopic surgery: A transtracheal approach for the thoracic cavity in a live canine model Yun-Hen Liu, MD, Yen-Chu, PhD,

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Presentation transcript:

Natural orifice transluminal endoscopic surgery: A transtracheal approach for the thoracic cavity in a live canine model Yun-Hen Liu, MD, Yen-Chu, PhD, Yi-Cheng Wu, MD, Chi-Ju Yeh, MD, Hui-Wen Chang, MS, Po-Jen Ko, MD, Hui-Ping Liu, MD The Journal of Thoracic and Cardiovascular Surgery Volume 141, Issue 5, Pages 1223-1230 (May 2011) DOI: 10.1016/j.jtcvs.2010.11.011 Copyright © 2011 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 The homemade endotracheal tube. The Journal of Thoracic and Cardiovascular Surgery 2011 141, 1223-1230DOI: (10.1016/j.jtcvs.2010.11.011) Copyright © 2011 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 A, Tracheal wall incision created with a homemade metallic knife. B, The tracheal wall incision was created with a sequential dilating technique. C and D, The costophrenic angle, chest wall, apex of the lung, and mediastinum were exposed after entering the thoracic cavity. The Journal of Thoracic and Cardiovascular Surgery 2011 141, 1223-1230DOI: (10.1016/j.jtcvs.2010.11.011) Copyright © 2011 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Pericardial window creation using a needle knife. The Journal of Thoracic and Cardiovascular Surgery 2011 141, 1223-1230DOI: (10.1016/j.jtcvs.2010.11.011) Copyright © 2011 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 A, Tracheal wound after tracheal approach for thoracic evaluation. B, Complete tracheal wound closure with 1 silicone stent. C, Complete tracheal wound closure with 2 silicone stents. D, Fourteen days after stent removal. The Journal of Thoracic and Cardiovascular Surgery 2011 141, 1223-1230DOI: (10.1016/j.jtcvs.2010.11.011) Copyright © 2011 The American Association for Thoracic Surgery Terms and Conditions

Figure 5 Change in white blood cell (WBC) counts in the 11 animals that survived thoracic exploration and pericardial window creation. The Journal of Thoracic and Cardiovascular Surgery 2011 141, 1223-1230DOI: (10.1016/j.jtcvs.2010.11.011) Copyright © 2011 The American Association for Thoracic Surgery Terms and Conditions

Figure 6 C-reactive protein (CRP) levels in the 11 animals that survived thoracic exploration and pericardial window creation. The Journal of Thoracic and Cardiovascular Surgery 2011 141, 1223-1230DOI: (10.1016/j.jtcvs.2010.11.011) Copyright © 2011 The American Association for Thoracic Surgery Terms and Conditions

Figure 7 A, Autopsy showing mild adhesion over the tracheal incision region. B, Autopsy showing mild adhesion over pericardium. C, Autopsy showing pleural cavity without infection. D, Complete healing of tracheal incision region without leakage. The Journal of Thoracic and Cardiovascular Surgery 2011 141, 1223-1230DOI: (10.1016/j.jtcvs.2010.11.011) Copyright © 2011 The American Association for Thoracic Surgery Terms and Conditions

Figure 8 A, Histologic examination revealed complete healing of the tracheal wall incision with fibrosis. The white arrows indicated the edges of the tracheal incision. B, High-power view of wound healing with fibrosis (arrowheads). C and D, Histologic examination revealed complete healing of the tracheal wall incision with cartilage regeneration (black arrow). The Journal of Thoracic and Cardiovascular Surgery 2011 141, 1223-1230DOI: (10.1016/j.jtcvs.2010.11.011) Copyright © 2011 The American Association for Thoracic Surgery Terms and Conditions