PURPOSE: We have previously reported the feasibility of the use of transoral surgical lung biopsy, an approach that may encourage the use of natural orifice transluminal endoscopic surgery (NOTES) for thoracic surgery. In this study, to assess the intraoperative safety of transoral surgical lung biopsy, we investigated its cardiopulmonary effects on survival in a canine model.
METHODS: Twenty-three dogs underwent transoral thoracic exploration that was performed using a flexible bronchoscope inserted via a homemade metallic tube placed through an incision in the vestibulum oris. A surgical lung biopsy was performed using an electrocautery snare and was accomplished using endoscopic grasping forceps that were inserted via the working channel of the bronchoscope. The cardiopulmonary parameters before, during, and after the surgery were continuously monitored and analyzed.
RESULTS: Correct surgical lung biopsy was achieved in 20 animals; the mean operative time was 60 mins (range, 16-111 mins). There was no evidence of procedure-related complications at the time of necropsy. Hemodynamic analysis showed that there was a significant fall in the mean arterial blood pressure (MAP) and heart rate (HR) during transoral thoracoscopy. However, cardiac index (CI) and global end-diastolic volume index (GEDVI) were well maintained during the surgery. On analyzing the effect of transoral thoracoscopy on gas exchange, we found that the partial arterial pressure of oxygen (PaO2) increased significantly after the surgery, but the pH and partial arterial pressure of CO2 (PaCO2) remained unchanged.
CONCLUSIONS: Thus, performing surgical lung biopsy using the transoral approach was found to be feasible and safe in a live canine model. Further large prospective studies comparing the NOTES and video-assisted thoracoscopic surgery (VATS) procedures will help determine the efficacy of NOTES for use in the case of patients with simple thoracic diseases.
CLINICAL IMPLICATIONS: We believe that transoral thoracic exploration combined with surgical lung biopsy can be considered as a safe technique that can be potentially used for patients with pleural and diffuse lung disease.
DISCLOSURE: The following authors have nothing to disclose: Yen Chu, Yi-Cheng Wu, Yun hen Liu, Po-Jen Ko, Hui-Ping Liu
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