Prova tipográfica.Thoracoscopic repair of esophageal atresia has becoming the gold standard
in many centers since it allows a better cosmetic result and avoids the
musculoskeletal sequelae of a thoracotomy. Natural Orifices Transluminal
Endocopic Surgery (NOTES) is a new surgical paradigm and its human
application was already started in some procedures. In the present study,
we explore the feasibility to perform an esophago-esophageal anastomosis
using a single transthoracic single port combined with a peroral access in a
rabbit model to simulate repair of esophageal atresia by hybrid NOTES in a
human newborn.
Adult male rabbits (Oryctolagus cuniculus, n=28) were utilized to perform
the surgical protocol. We used a transthoracic telescope with a 3 mm
working channel and a flexible endoscope with a 2.2 mm working channel
by peroral access. We performed total esophagotomy with peroral scissors
followed by an esophago-esophageal anastomosis achieved with rigid
transthoracic scope helped by peroral operator. Extracorporeal transthoracic knots were performed to complete anastomosis. The
anastomoses were examined in loco and ex loco, after animal sacrifice.
We successfully accomplished a complete esophageal anastomosis in all
rabbits using a combination of transthoracic and peroral 3mm instruments.
This study provides important insights for a possible translation of hybrid
NOTES to human newborns with esophageal atresia. Forward studies to
accomplish their feasibility in human newborns will still be necessary.2010 IPEG Research Gran
