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NOTES: Current Status and New Horizons
Mouen A. Khashab, Anthony N. Kalloo Gastroenterology Volume 142, Issue 4, Pages e1 (April 2012) DOI: /j.gastro Copyright © 2012 AGA Institute Terms and Conditions
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Figure 1 Submucosal tunneling technique for transesophageal mediastinoscopy. (A) saline/methylene blue solution is injected into the submucosa. (B) Needle knife mucosal/submucosal puncture. (C) Creation of submucosal space by blunt dissection and/or balloon dilation. (D) Off-site needle knife penetration of the muscularis propria with subsequent entry into the mediastinum (see inset). (E) Offset closure of muscular defect with overlying mucosal flap. Gastroenterology , e1DOI: ( /j.gastro ) Copyright © 2012 AGA Institute Terms and Conditions
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Figure 2 Fluoroscopic view of endoscopic vertebral bone biopsy.
Gastroenterology , e1DOI: ( /j.gastro ) Copyright © 2012 AGA Institute Terms and Conditions
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Figure 3 Tissue expansion technique to facilitate dissection during NOTES as compared with laparoscopic resection. (A) NOTES cholecystectomy. (B) Laparoscopic cholecystectomy. (Ai) An endoscope is passed into the peritoneum through a transgastric approach and the gallbladder is visualized. (Aii) Gallbladder fossa is injected to “lift” gallbladder away from its bed. (Aiii) Subsequently, gallbladder is dissected using needle knife. (Bi) Several transabdominal trocars are placed. (Bii) Gallbladder is retracted away from its fossa before resection. (Biii) Laparoscopic resection of gallbladder after retraction. Gastroenterology , e1DOI: ( /j.gastro ) Copyright © 2012 AGA Institute Terms and Conditions
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