Legacy Health System, Portland, OR, USA,
Surg Endosc. 2010 Sep;24(9):2120-7. doi: 10.1007/s00464-010-0908-2. Epub 2010 Feb 23.
Mediastinal surgery most often is performed via a transthoracic or transabdominal approach; however, the pre- and paratracheal mediastinum can be readily accessed with a transcervical approach. The purpose of this study was to evaluate the feasibility, safety, and success rate of using a transcervical approach and flexible endoscopes to perform mediastinal surgery also in the retro- and paraesophageal mediastinum.
Mediastinal operations on four live pigs and one human cadaver were performed using standard endoscopes through a small cervical incision. The procedure involved marking of four mediastinal lymph nodes using endoscopic ultrasound (EUS). The esophagus was dissected to the phrenoesophageal junction by creating connective tissue tunnels with balloon dilatation and low-pressure CO(2) insufflation. Heller myotomy was performed followed by sequential identification and removal of the marked nodes. Success rate of esophageal dissection to the diaphragm, Heller myotomy, directed mediastinal lymph node harvest, and complication rates were evaluated.
Dissection of the esophagus to the diaphragm was achieved in 100% of attempts. Distal esophageal myotomy was performed in all cases. Harvest of marked lymph nodes (ln) was successful in 100% of animals (16/16 ln) and cadavers (2/2 ln). One major complication was recorded in the pig group (tension pneumomediastinum).
The entire visceral mediastinum can be successfully accessed through a transcervical incision using flexible endoscopes. Directed lymph node harvest and esophageal myotomy is feasible with a high success rate. Connective tissue tunnels are safe, atraumatic, and a promising concept for targeted mediastinal exploration. With refinement in technology, this approach may be useful for a variety of mediastinal surgeries.
纵隔手术通常通过经胸或经腹入路进行；然而，经颈入路可以方便地进入前纵隔和气管旁纵隔。本研究的目的是评估使用经颈入路和柔性内镜对后纵隔和食管旁纵隔进行纵隔手术的可行性、安全性和成功率。
通过小的颈部切口，使用标准内镜对四只活猪和一具人体尸体进行纵隔手术。该过程涉及使用内镜超声（EUS）标记四个纵隔淋巴结。通过球囊扩张和低压 CO2 注入创建结缔组织隧道，将食管解剖至膈食管连接部。进行 Heller 肌切开术，然后依次识别和切除标记的淋巴结。评估食管至膈肌的解剖成功率、Heller 肌切开术、定向纵隔淋巴结采集和并发症发生率。
100%的尝试都成功地将食管解剖至膈肌。所有病例均进行了远端食管肌切开术。在所有动物（16/16 ln）和尸体（2/2 ln）中，成功采集到标记的淋巴结（ln）。在猪组记录到 1 例主要并发症（张力性纵隔气肿）。
使用柔性内镜，可通过经颈切口成功进入整个内脏纵隔。定向淋巴结采集和食管肌切开术具有很高的成功率。结缔组织隧道是安全的，无创伤的，并且是一种有前途的靶向纵隔探查概念。随着技术的改进，这种方法可能对各种纵隔手术有用。
