Endoscopy
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Physiologic reactions during natural orifice transluminal endoscopic surgery (NOTES) may differ from those at laparoscopy. This experimental study assessed the effect of pneumoperitoneum induced by endoscope air pump on hemodynamics and inspiratory pressures during transgastric peritoneoscopy. ⋯ On-demand insufflation with a standard endoscopic light source/insufflator resulted in a marked median increase and wide variation in IAP throughout transgastric peritoneoscopy. Hemodynamic changes were moderate. However, major increases in PIP suggest a need for stricter control of intra-abdominal hypertension during NOTES.
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Natural orifice transluminal endoscopic surgery (NOTES) within the peritoneal cavity is rapidly evolving, using transgastric, transcolonic, or transvaginal access. There is little experience with transesophageal NOTES access to the mediastinum. This prospective long-term animal survival study was performed to explore the feasibility and safety of transesophageal intrathoracic procedures including minor surgery. ⋯ Transmural esophageal incision and endoscopic partial mediastinoscopy including therapeutic procedures on the heart or mediastinum proved feasible in long-term survival animal studies. Clip closure of the defect was effective, but did not close the esophageal muscle layer. Other means such as endoscopic suturing appear to be preferable.