4.6 Article

Endoscopic trans-esophageal submucosal tunneling surgery: A new therapeutic approach for diseases located around the aorta ventralis

Journal

WORLD JOURNAL OF GASTROENTEROLOGY
Volume 25, Issue 1, Pages 85-94

Publisher

BAISHIDENG PUBLISHING GROUP INC
DOI: 10.3748/wjg.v25.i1.85

Keywords

Endoscopic trans-esophageal submucosal tunneling surgery; Diseases around the aorta ventralis; Endoscopic submucosal tunneling technique; Abdominal surgery; Animal model

Funding

  1. Scientific Research Support Fund for Chinese PLA General Hospital [2012FC-TSYS-3035]

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AIM To assess the efficiency of endoscopic trans-esophageal submucosal tunneling surgery (EESTS) technique for diseases located around the aorta ventralis. METHODS Nine pigs were assigned to EESTs. The procedures were as follows: First, a long esophageal submucosal tunnel was established. Second, full-thickness myotomy was created. Third, an endoscope was entered into the abdominal cavity through a muscle incision and the endoscope was around the aorta ventralis. Eventually, celiac trunk ganglion neurolysis, partial hepatectomy and splenectomy, partial tissue resection in the area of the posterior peritoneum, and endoscopic submucosal dissection (ESD) combined with lymph node dissection were performed. The animals were given antibiotics for 5 d and necropsied 7 d after surgery. RESULTS In all surgeries, one pig died from intraperitoneal hemorrhage after doing partial splenectomy, while the other pigs were alive after successfully operating other surgeries. For surgery of celiac trunk ganglion damage, at necropsy, there was no exudation in the abdominal cavity. Regarding surgery of partial hepatectomy, the wound with part healing was observed in the left hepatic lobe, and no bleeding or obvious exudation was seen. In surgery of partial splenectomy, massive hemorrhage was observed on the splenic wound surface, and the metal clips could not stop bleeding. After surgery of retroperitoneal tissue resection, mild tissue adhesion was observed in the abdominal cavity of one animal, and another one suffered from severe infection. For surgery of ESD and lymph node dissection, a moderate tissue adhesion was observed. CONCLUSION EESTS is a feasible and safe technique for diseases located around the aorta ventralis.

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