Natural orifice transesophageal thoracoscopic surgery: A review of the current state

Figure 2 Transesophageal mediastinoscopy technique. A: Saline-solution-injection test to confirm needle-tip entry into the submucosa; B: Gas submucosal dissection with high-pressure CO2; C: Muscular-layer resection with cap-EMR technique inside of the submucosal space; D: Offset closure of the muscular defect with overlying mucosal flap. Reproduced with permission from Sumiyama et al[24].