New methodExperimental endoscopyFeasibility of endoscopic transesophageal thoracic sympathectomy (with video)
Section snippets
Materials and methods
This study was approved by the subcommittee for research animal care at the Massachusetts General Hospital, Boston, MA. The aim of the study was to assess the technical feasibility of peroral transesophageal sympathectomy in a nonsurvival animal model. The 8 fasted Yorkshire swine underwent general anesthesia with induction by Telazol 4.4 mg/kg intramuscular (A.H. Robins, Richmond, VA) plus xylazine 2.2 mg/kg intramuscular and endotracheal intubation. Anesthesia was maintained with isoflurane
Results
Transesophageal NOTES access to the mediastinum and chest cavity was successfully performed in all swine (mean weight 45.3 ± 5 lb). There were no complications during mucosectomy, creation of the submucosal tunnel, or entrance into the mediastinum. A colonoscope was used in 2 swine to perform a sympathectomy at the higher T2 level. Later, it was discovered that a standard 2-channel gastroscope provided adequate maneuverability and length to reach target sites. Sympathectomy was performed in 7 of
Discussion
This study reports the first use of transesophageal NOTES access to perform thoracic sympathectomy and demonstrates technical feasibility of the transesophageal approach. We were able to successfully visualize and identify the appropriate thoracic level in all animals and performed sympathectomy at the desired location in 7 out of 8 swine. In our early experience with the procedure, the sympathetic chain was difficult to identify, and muscle fibers were transected in lieu of ganglia. Even in
Acknowledgment
We thank Cook Medical, Inc, for their generous donation of supplies.
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Cited by (18)
The History of Sympathetic Surgery
2016, Thoracic Surgery ClinicsCitation Excerpt :However, the instigators of this technique have been using it in humans56 with apparent success.57 A second access was examined by the NOTES (natural orifice translumenal endoscopic surgery) principle in an animal study using the transesophageal route.58 The investigators succeeded in performing a bilateral thoracic sympathetic ablation by this technique, proving the feasibility of the method.
One-year follow-up period after transumbilical thoracic sympathectomy for hyperhidrosis: Outcomes and consequences
2014, Journal of Thoracic and Cardiovascular SurgeryCitation Excerpt :The main explanation for these problems was the trauma to the intercostal nerve when the trocars were introduced into the pleural cavity. To find surgical procedures that avoid chest incisions and reduce the number of ports, Turner et al9 and Yang et al10 conducted an animal study using the technique of NOTES to perform endoscopic thoracic sympathetic trunk resection via the esophagus or oral vestibular incision. Despite the substantial work in the NOTES field, it is clear that there is a long way to go from the present animal experiments to clinical practice.
A novel approach to treat women patients with palmar hyperhidrosis: Transumbilical thoracic sympathectomy with an ultrathin gastroscope
2013, Annals of Thoracic SurgeryCitation Excerpt :There is a trend of growing application of flexible endoscopic surgery in thoracic practice, such as peroral endoscopic myotomy and endoscopic submucosal dissection [11–13]. Turner and colleagues [14] used a flexible endoscope to conduct transesophageal thoracic sympathectomy in animal models; however, this method was technically demanding, which precluded its widespread application to patients. By drawing on flexible endoscopic surgery, we developed a novel surgical technique for performance of sympathectomy by natural orifices transumbilical surgery in women patients without thoracotomy.
Thoracoscopic Sympathectomy versus Thoracoscopic Sympathotomy for The Treatment of Primary Palmar Hyperhidrosis in Children and Adolescents
2022, Al-Azhar International Medical Journal
DISCLOSURE: This project was fundedby the Center for Integration of Medicine and Innovative Technology. Dr Brugge disclosed a consultant relationship with Boston Scientific. All other authors disclosed no other financial relationships relevant to this publication.
The video from this article was presented at the 4th International NOSCAR Conference on NOTES, July [9-11], 2009, Boston, MA.