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Endoscopy 2010; 42(6): 468-474
DOI: 10.1055/s-0029-1244019
Original article

© Georg Thieme Verlag KG Stuttgart · New York

Randomized comparative long-term survival study of endoscopic and thoracoscopic esophageal wall repair after NOTES mediastinoscopy in healthy and compromised animals

A.  Fritscher-Ravens1 , T.  Cuming1 , C.  F.  Eisenberger2 , M.  Ghadimi2 , A.  Nilges2 , P.  Meybohm3 , S.  Schiffmann4 , B.  Jacobsen5 , F.  Seehusen5 , H.  Niemann6 , W.  T.  Knoefel2
  • 1Homerton University Hospital, London, UK
  • 2Department of Surgery, Heinrich-Heine-Universität, Düsseldorf, Germany
  • 3Department of Anaesthesia, University Hospital Schleswig-Holstein-Campus Kiel, Germany
  • 4Department of Pathology, Heinrich-Heine-Universität, Düsseldorf, Germany
  • 5Department of Pathology, University of Veterinary Medicine Hannover, Germany
  • 6Friedrich Loeffler Institute for Farm Animal Genetics, Mariensee, Germany
Further Information

Publication History

submitted 27 September 2009

accepted after revision 9 February 2010

Publication Date:
23 March 2010 (online)

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Commentaire de travail de A. Fritscher-Ravens et al., pp. 468Endoscopy 2010; 42(06): 523-523
DOI: 10.1055/s-0031-1291865

Background and study aims: Natural orifice transluminal endoscopic surgery (NOTES) has not yet been widely adopted because of lack of suitable equipment and fear of possible serious complications, especially in the mediastinum. We compared endoscopic with thoracoscopic esophageal wall repair after full-thickness esophageal wall incision (FTEI) and NOTES mediastinoscopy in healthy versus compromised animals.

Methods: After FTEI for mediastinoscopy, 24 pigs (12 healthy, 12 compromised) were randomly allocated to endoscopic or thoracoscopic repair (each arm of each group, n = 6). They were kept alive for 3 months after endoscopic closure with prototype T-anchor suturing or thoracoscopic repair.

Results: FTEI and mediastinoscopy were uneventful in all as was the initial repair of the incision (mean repair times: thoracoscopic 65 ± 3.2 minutes, endoscopic 52 ± 5.1 minutes; P < 0.0005). Post procedure, all 12 healthy pigs thrived with no complications or deaths. Two compromised animals died during the preparation period, and had to be replaced. In the compromised group, during endoscopic repair, 2 / 6 pigs suffered from gastric reflux into esophagus and mediastinum; the repair was completed and the pigs kept alive; one subsequently died of mediastinitis, and in the other, autopsy showed a gastric abscess in the lower mediastinum. Regarding the compromised thoracoscopic subgroup, one animal died from mediastinitis and all had abscesses at or near the incision sites.

Conclusion: Transesophageal mediastinoscopy could be performed equally well as the transthoracic procedure, both in healthy and compromised animals. However, on follow-up, the compromised animals had worse outcomes, with more complications and two deaths (17 %), one in each arm.

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A. Fritscher-RavensMD 

Homerton University Hospital

London E9 6SR
UK

Fax: +44-20-88510849

Email: fri.rav@btopenworld.com

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