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Natural orifice translumenal endoscopic surgery for anterior spinal procedures.

Magno P, Khashab MA, Mas M, Giday SA, Buscaglia JM, Shin EJ, Dray X, Kalloo AN - Minim Invasive Surg (2012)

Bottom Line: The posterior mediastinum was successfully accessed and navigated in all animals.Bone biopsy was successfully performed without complications, but the hardness of bone tissue resulted in small and fragmented samples.Conclusions.

View Article: PubMed Central - PubMed

Affiliation: Division of Gastroenterology and Hepatology, University of Puerto Rico School of Medicine, San Juan, PR 00936, USA.

ABSTRACT
Background. NOTES techniques allow transesophageal access to the mediastinum. The aim of this study was to assess the feasibility of transesophageal biopsy of thoracic vertebrae. Methods. Nonsurvival experiments on four 50-kg porcine animals were performed. Transesophageal access to the mediastinum was attained using submucosal tunneling technique. Results. The posterior mediastinum was successfully accessed and navigated in all animals. Vertebral bodies and intervertebral spaces were easily approached while avoiding damage to adjacent vessels. Bone biopsy was successfully performed without complications, but the hardness of bone tissue resulted in small and fragmented samples. Conclusions. Peroral transesophageal access into the posterior mediastinum and thoracic vertebral bone biopsy was feasible and safe. The proximity of the esophagus to the vertebral column provides close and direct access to the thoracic spine and opens up new ground for the performance of multilevel anterior spine procedures using NOTES techniques.

No MeSH data available.


Related in: MedlinePlus

Transesophageal approach to the anterior thoracic spine. (a) Incision over the anterior longitudinal ligament and exposure of the intravertebral space and vertebral bone. (b) Insertion of the 19 gauge needle in the thoracic vertebrae. (c) Fluoroscopic view of vertebral bone biopsy.
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Related In: Results  -  Collection


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fig3: Transesophageal approach to the anterior thoracic spine. (a) Incision over the anterior longitudinal ligament and exposure of the intravertebral space and vertebral bone. (b) Insertion of the 19 gauge needle in the thoracic vertebrae. (c) Fluoroscopic view of vertebral bone biopsy.

Mentions: Transesophageal interventions in the thoracic spine were successful in all animals. The incision through the anterior longitudinal ligament and subsequent exposure of vertebral bone tissue and intervertebral spaces at the level of the proximal, middle, and distal thoracic spine were successfully completed while avoiding damage to the adjacent vessels. Bone biopsies were successfully obtained from selected thoracic vertebral bodies (T4, T8, T12). Fluoroscopy was used to confirm precise vertebral location. However, the hardness of cortical bone tissue resulted in fragmented bone samples using both forceps and needles, and limited the insertion of the 19 gauge needle to approximately one centimeter into the vertebra as seen under fluoroscopy (Figures 3(a)–3(c)). After 4-5 attempts, the 19 gauge needle was inserted under fluoroscopy guidance approximately one centimeter into the vertebra. Once inserted within the vertebral body and visualized in place under fluoroscopy, the 19 g needle was withdrawn and flushed with water to obtain the specimen. The specimen consisted of fragmented particles (1–3 fragments). These particles were visually inspected and palpated to confirm the presence of bone particles as a measure of sample adequacy (the purpose was to assess the presence or absence of bone material). The median time for entire procedure was 77 minutes (range, 52–93 minutes).


Natural orifice translumenal endoscopic surgery for anterior spinal procedures.

Magno P, Khashab MA, Mas M, Giday SA, Buscaglia JM, Shin EJ, Dray X, Kalloo AN - Minim Invasive Surg (2012)

Transesophageal approach to the anterior thoracic spine. (a) Incision over the anterior longitudinal ligament and exposure of the intravertebral space and vertebral bone. (b) Insertion of the 19 gauge needle in the thoracic vertebrae. (c) Fluoroscopic view of vertebral bone biopsy.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3368208&req=5

fig3: Transesophageal approach to the anterior thoracic spine. (a) Incision over the anterior longitudinal ligament and exposure of the intravertebral space and vertebral bone. (b) Insertion of the 19 gauge needle in the thoracic vertebrae. (c) Fluoroscopic view of vertebral bone biopsy.
Mentions: Transesophageal interventions in the thoracic spine were successful in all animals. The incision through the anterior longitudinal ligament and subsequent exposure of vertebral bone tissue and intervertebral spaces at the level of the proximal, middle, and distal thoracic spine were successfully completed while avoiding damage to the adjacent vessels. Bone biopsies were successfully obtained from selected thoracic vertebral bodies (T4, T8, T12). Fluoroscopy was used to confirm precise vertebral location. However, the hardness of cortical bone tissue resulted in fragmented bone samples using both forceps and needles, and limited the insertion of the 19 gauge needle to approximately one centimeter into the vertebra as seen under fluoroscopy (Figures 3(a)–3(c)). After 4-5 attempts, the 19 gauge needle was inserted under fluoroscopy guidance approximately one centimeter into the vertebra. Once inserted within the vertebral body and visualized in place under fluoroscopy, the 19 g needle was withdrawn and flushed with water to obtain the specimen. The specimen consisted of fragmented particles (1–3 fragments). These particles were visually inspected and palpated to confirm the presence of bone particles as a measure of sample adequacy (the purpose was to assess the presence or absence of bone material). The median time for entire procedure was 77 minutes (range, 52–93 minutes).

Bottom Line: The posterior mediastinum was successfully accessed and navigated in all animals.Bone biopsy was successfully performed without complications, but the hardness of bone tissue resulted in small and fragmented samples.Conclusions.

View Article: PubMed Central - PubMed

Affiliation: Division of Gastroenterology and Hepatology, University of Puerto Rico School of Medicine, San Juan, PR 00936, USA.

ABSTRACT
Background. NOTES techniques allow transesophageal access to the mediastinum. The aim of this study was to assess the feasibility of transesophageal biopsy of thoracic vertebrae. Methods. Nonsurvival experiments on four 50-kg porcine animals were performed. Transesophageal access to the mediastinum was attained using submucosal tunneling technique. Results. The posterior mediastinum was successfully accessed and navigated in all animals. Vertebral bodies and intervertebral spaces were easily approached while avoiding damage to adjacent vessels. Bone biopsy was successfully performed without complications, but the hardness of bone tissue resulted in small and fragmented samples. Conclusions. Peroral transesophageal access into the posterior mediastinum and thoracic vertebral bone biopsy was feasible and safe. The proximity of the esophagus to the vertebral column provides close and direct access to the thoracic spine and opens up new ground for the performance of multilevel anterior spine procedures using NOTES techniques.

No MeSH data available.


Related in: MedlinePlus