Feasibility of Endoscopic Transumbilical Thoracic Surgical Lung Biopsy and Pericardial Window Creation

 BACKGROUND To date there are no practical platforms for performing natural orifice transluminal endoscopic surgery (NOTES) in the thoracic cavity. Using the canine model, this study evaluates the feasibility of single incision transumbilical endoscopic surgery for thoracic exploration, lung biopsy, and pericardial window creation.
METHODS Eight dogs were used for this study. A homemade metallic tube was advanced into the abdominal cavity via a 12 mm umbilical incision. The metallic tube was advanced into the thoracic cavity through a subxyphoid diaphragmatic incision under video guidance. Access to the thoracic cavity was achieved by a flexible bronchoscope via the metallic tube. Surgical lung biopsy and pericardial window creation were performed using an electrocautery loop and needle knife. The animals were euthanized after surgery for necropsy.
RESULTS All pericardial window creations and 18 of 19 predetermined lung biopsies were completed in a median time of 67.85 minutes (range 55-105 minutes).One dog developed post-procedure pneumothorax. Autopsy revealed no signs of vital organ injury or infection.
CONCLUSIONS The study demonstrated that transumbilical thoracoscopic surgical lung biopsy and pericardial window creation is feasible. The safety and efficacy of the transumbilical approach need to be verified by a more detailed survival study.

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