De Palma G D, Siciliano S, Addeo P, Salvatori F, Persico M, Masone S, Rega M, Maione F, Coppola Bottazzi E, Serrao E, Adamo M, Persico G
Department of Surgery and Advanced Technologies, Center for Technical Innovation in Surgery (ITC), University of Naples Federico IISchool of Medicine, Naples, Italy.
Minerva Chir. 2010 Feb;65(1):11-5.
Recently the NOTES approach has been extended to mediastinum by a transesophageal access and to the thorax by a transvescical endoscopic approach. The aim of this study was to assess the feasibility and the safety of transgastric endoscopic approach to the thoracic cavity, with lung biopsy, in a survival porcine model.
The study was performed on four 20-30 kg female pigs (Sus scrofus domesticus). Following gastric wall incision, the muscular pars of the left diaphragmatic dome was incised along with the parietal pleura and the endoscope advanced into the thoracic cavity. In all animals, a thoracoscopy was performed as well as peripheral lung biopsy. At the end of the operation the endoscope was withdrawn from the thoracic cavity after pleural sac decompression and the diaphragmatic incision closed by endoscopic clips under maximal expansion of lungs. The gastric incision was finally closed by endoscopic clips. Chest-tube placement was not utilized. Animals were sacrificed by day 15 postoperatively.
The gastroscope was easily introduced into the thoracic cavity that allowed to visualize the pleural cavity and to perform simple surgical procedures such as lung biopsies without complications. There were neither respiratory distress episodes nor surgical complications to report. No adverse event occurred during the survival period. The postmortem examination 15 days after surgery revealed a good closure of the diaphragmatic incision. At necropsy, the lung biopsies were completely healed. There were no signs of infection in both thoracic and peritoneal cavities. The length of follow-up and number of animals studied might have not been sufficient.
This study demonstrates the feasibility of transgastric thoracoscopy in porcine model. Long-term follow-up of much larger series will be necessary for provision of more reliable answers if this approach should be adopted in the future and eventually translated for humans with advantages for patients.
最近，经自然腔道内镜手术（NOTES）方法已通过经食管途径扩展至纵隔，并通过经膀胱内镜途径扩展至胸腔。本研究的目的是在存活的猪模型中评估经胃内镜进入胸腔进行肺活检的可行性和安全性。
对4只体重20 - 30千克的雌性猪（家猪）进行研究。在切开胃壁后，沿着左膈穹窿的肌层以及壁层胸膜切开，将内镜推进到胸腔。在所有动物中，均进行了胸腔镜检查以及周边肺活检。手术结束时，在胸腔减压后将内镜从胸腔取出，在肺最大扩张的情况下通过内镜夹关闭膈肌切口。最后通过内镜夹关闭胃切口。未放置胸管。术后第15天处死动物。
胃镜很容易进入胸腔，能够观察到胸膜腔并进行简单的外科手术，如肺活检，且无并发症。没有呼吸窘迫发作或手术并发症的报告。在存活期内未发生不良事件。术后15天的尸检显示膈肌切口愈合良好。尸检时，肺活检部位已完全愈合。胸腔和腹腔均无感染迹象。随访时间和研究动物数量可能不足。
本研究证明了经胃胸腔镜检查在猪模型中的可行性。如果将来采用这种方法并最终应用于人类患者以使其受益，还需要对更大规模的系列进行长期随访，以提供更可靠的答案。
