Published online Jan 7, 2019. doi: 10.3748/wjg.v25.i1.85
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
To assess the efficiency of endoscopic trans-esophageal submucosal tunneling surgery (EESTS) technique for diseases located around the aorta ventralis.
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.
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.
EESTS is a feasible and safe technique for diseases located around the aorta ventralis.
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.