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

Table 1 Access techniques and interventions performed in swine transesophageal NOTES studies

Study	Year	Number ofsubjects (n)	Survival study (Yes/No), (n)	Days survived, (n)	Esophagotomymethod	Intervention (s) performed
Fritscher-Ravens et al[23]	2007	9	Yes2, n = 3	14, (n = 3)	Needle-knife	Mediastinoscopy, thoracoscopy, myocardial and left atrium saline injection, pericardial fenestration, lymphadenectomy
			Yes, n = 4	28, (n = 1)
			No, n = 2	42, (n = 3)
Sumiyama et al[24]	2007	4	Yes2	14	SEMF	Mediastinoscopy
Gee et al[21]	2008	4	Yes1	8, (n = 2)	m-SEMF	Pleural biopsy, Mediastinoscopy, thoracoscopy
				12, (n = 2)
Sumiyama et al[34]	2008	5	Yes2	7	SEMF	Mediastinoscopy, thoracoscopy, pericardial window, epicardial ablation
Willingham et al[22]	2008	5	No1	0	m-SEMF	Mediastinoscopy, thoracoscopy, pleural biopsy

¹Denotes administration of pre-operative antibiotics only (1 g Ancef);

²Represents post-operative antibiotics (5-7 d enrofloxacin). SEMF: Submucosal endoscopy with mucosal flap safety valve; m-SEMF: Modified SEMF.

Table 2 Closure techniques and associated complications in swine transesophageal NOTES studies

Study	Esophageal closure strategy	Early complications	Late complications	Morbidity (n)	Mortality (%), (n)
Fritscher-Ravens et al[23]	Prototype T-tag device (n = 6)	Pericardial hematoma (acute animal)	None	1	None
	EndoClip (n = 3)
Sumiyama et al[24]	SEMF	Pleural injury resulting in death	None	None	25 (n = 1)
Gee et al[21]	m-SEMF + Endoclip (n = 2), m-SEMF only (n = 2)	None	Subclinical esophageal abscess	1	None
Sumiyama et al[34]	SEMF + EndoClip	Descending aorta injury	Esophageal mucosal ulceration at SEMF site	1	20 (n = 1)
Willingham et al[22]	m-SEMF + EndoClip	Pneumothorax requiring angiocatheter decompression	N/A	1	None

EndoClip: Metal clip applied to esophageal mucosa; N/A: Not applicable in this non-survival study.