Comparative study of NOTES alone versus NOTES guided by a new image registration system for navigation in the mediastinum: a study in a porcine model

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• 作者：Henry Có ; rdova ; MD¹ ; Raú ; l San José ; Esté ; par ; PhD⁵ ; Antonio Rodr&#237 ; guez-D'Jesú ; s ; MD¹ ; Graciela Mart&#237 ; nez-Pall&#237 ; MD ; PhD² ; Pedro Arguis ; MD ; PhD³ ; Cristina Rodr&#237 ; guez de Miguel¹ ; Ricard Navarro-Ripoll ; MD² ; Juan M. Perdomo ; MD² ; Miriam Cuatrecasas ; MD ; PhD⁴ ; Josep Llach ; MD ; PhD¹ ; Kirby G. Vosburgh ; MD ; PhD⁵ ; Gloria Ferná ; ndez-Esparrach ; MD ; PhD¹ ;
• 关键词：3D ; 3-dimensional ; IRS ; image registration system ; MED ; mediastinoscopy ; NOTES ; natural orifice transluminal endoscopic surgery
• 刊名：Gastrointestinal Endoscopy
• 出版年：2013
• 出版时间：January, 2013
• 年：2013
• 卷：77
• 期：1
• 页码：102-107
• 全文大小：956 K

文摘

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Background

Natural orifice transluminal endoscopic surgery (NOTES) mediastinoscopy (MED) through the esophagus has proved to be feasible in the animal model. However, injury of the adjacent pleura and pneumothorax has been reported as a frequent adverse event when using a blind access.

Objective

To assess the utility and safety of a CT-based image registration system (IRS) for navigation in the mediastinum.

Design

Prospective, randomized, controlled trial in 30 Yorkshire pigs. Thirty-minute MEDs were performed: 15 MEDs were performed with IRS guidance (MED-IRS), and 15 MEDs were performed with a blind access.

Setting

Animal research laboratory.

Interventions

In both groups, the mediastinum was accessed through a 10-cm submucosal tunnel in the esophageal wall. Timed exploration was performed with identification of 8 mediastinal structures.

Main Outcome Measurements

Technical feasibility, adverse events, and the number of mediastinal structures identified.

Results

Thirty animals weighing 31.5 ¡À 3.5 kg were included in this study. MED was not possible in 2 animals in the ¡°MED with blind access¡± group but was possible in all MEDs performed with IRS. The mean number of identified organs was slightly higher in ¡°with IRS-MED¡± (6.13 ¡À 1.3) than with MED with blind access (4.7 ¡À 2.3; m>Pm> = .066). Moreover, the right atrium and vena cava were identified in more cases with IRS-MED than in MED with blind access (13 vs 3 and 15 vs 11, m>Pm> = .000 and m>Pm> = .03, respectively). There were 3 (23 % ) adverse events with IRS-MED and 4 (27 % ) with ¡°MED with blind access¡± (m>Pm> = not significant), with pneumothorax being the most frequent (2 and 3, respectively).

Limitations

Nonsurvival animal study.

Conclusions

This study demonstrates that the IRS system appears feasible in natural orifice transluminal endoscopic surgery MED and suggests that IRS guidance might be useful for selected procedures.