Basic Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 7, 2019; 25(1): 85-94
Published online Jan 7, 2019. doi: 10.3748/wjg.v25.i1.85
Endoscopic trans-esophageal submucosal tunneling surgery: A new therapeutic approach for diseases located around the aorta ventralis
Ying Xiong, Qian-Qian Chen, Ning-Li Chai, Shun-Chang Jiao, En-Qiang Ling Hu
Ying Xiong, Qian-Qian Chen, Ning-Li Chai, En-Qiang Ling Hu, Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing 100853, China
Ying Xiong, Department of Gastroenterology and Hepatology, No. 1 Central Hospital of Baoding, Baoding 071000, Hebei Province, China
Shun-Chang Jiao, Department of Oncology, Chinese PLA General Hospital, Beijing 100853, China
Author contributions: Xiong Y and Chen QQ are both the first authors and contributed equally to this work. Ling Hu EQ and Jiao SC designed the research and are both corresponding authors ; Xiong Y performed the research; Chai NL contributed new reagents or analytic tools; Chen QQ analyzed the data; Chen QQ and Xiong Y wrote the paper.
Supported by Scientific Research Support Fund for Chinese PLA General Hospital, No. 2012FC-TSYS-3035.
Institutional animal care and use committee statement: This study was approved by the Institutional Animal Care and Use Committee of the Chinese PLA General Hospital, Beijng, China. Appropriate measures were taken to minimize pain or discomfort of the animals.
Conflict-of-interest statement: The authors declare that there is no conflict of interest regarding the publication of this article.
Data sharing statement: Technical appendix, statistical code, and dataset are available from the corresponding author at enqianglinghu2017@163.com and jiaoshunchang001@163.com.
ARRIVE guidelines statement: The ARRIVE guidelines have been adopted.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: En-Qiang Ling Hu, MD, PhD, Chief Doctor, Professor, Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing 100853, China. linghuenqiang@sina.vip.com
Telephone: +86-10-55499405 Fax: +86-404-55499305
Received: May 27, 2018
Peer-review started: May 27, 2018
First decision: July 4, 2018
Revised: August 22, 2018
Accepted: October 5, 2018
Article in press: October 5, 2018
Published online: January 7, 2019
Processing time: 225 Days and 22.3 Hours
Abstract
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.

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

Core tip: Endoscopic trans-esophageal submucosal tunneling surgery (EESTS) technique is a new branch of endoscopic tunneling technology for diagnosing and treating diseases located around the aorta ventralis. The objective of our study was to simulate surgeries in a porcine model and to assess the efficiency of this new strategy. The surgeries included celiac trunk ganglion neurolysis, partial hepatectomy and splenectomy, partial tissue resection in the area of the posterior peritoneum, and endoscopic submucosal dissection combined with lymph node dissection. And we confirmed that EESTS is a feasible and safe technique.