title: Transvesical thoracoscopy: a natural orifice translumenal endoscopic approach for thoracic surgery.
abstract: BACKGROUND
  Recently there has been an increasing enthusiasm for using natural orifices translumenal endoscopic surgery (NOTES) to perform scarless abdominal procedures. We have previously reported the feasibility and safety of the transvesical endoscopic peritoneoscopy in a long-term survival porcine model as useful for those purposes. Herein, we report our successful experience performing transvesical and transdiaphragmatic endoscopic approach to the thoracic cavity in a long-term survival study in a porcine model.
  
  
  METHODS
  Transvesical and transdiaphragmatic endoscopic thoracoscopy was performed in six anesthetized female pigs. A 5 mm transvesical port was created on the bladder wall and an ureteroscope was advanced into the peritoneal cavity. After diaphragm inspection, we introduced through the left diaphragmatic dome a ureteroscope into the left thoracic cavity. In all animals, we performed thoracoscopy as well as peripheral lung biopsy. Animals were sacrificed by day 15 postoperatively.
  
  
  RESULTS
  We easily introduced a 9.8 Fr ureteroscope into the thoracic cavity that allowed us to visualize the pleural cavity and to perform simple surgical procedures such as lung biopsies without complications. There were neither respiratory distress episodes nor surgical complications to report. Postmortem examination revealed complete healing of vesical and diaphragmatic holes, whereas no signs of infection or adhesions were observed in the peritoneal or thoracic cavities.
  
  
  CONCLUSIONS
  This study demonstrates the feasibility of transvesical thoracoscopy in porcine model. However, although this study extends the potential applications of NOTES to the thoracic cavity, new instruments and further work are needed to provide evidence that this could be translated to humans and with advantages for patients.
authors.affiliation: Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal.
authors.forename: Estêvão
authors.initials: E
authors.lastname: Lima
authors.forename: Tiago
authors.initials: T
authors.lastname: Henriques-Coelho
authors.forename: Carla
authors.initials: C
authors.lastname: Rolanda
authors.forename: José M
authors.initials: JM
authors.lastname: Pêgo
authors.forename: David
authors.initials: D
authors.lastname: Silva
authors.forename: José L
authors.initials: JL
authors.lastname: Carvalho
authors.forename: Jorge
authors.initials: J
authors.lastname: Correia-Pinto
mesh_terms: D000818:Animals; D001706:Biopsy / Q000379:methods; D003964:Diaphragm / Q000601:surgery; D005240:Feasibility Studies; D005260:Female; D008168:Lung / Q000473:pathology*; D013552:Swine; D013906:Thoracoscopy / Q000379:methods*; D001743:Urinary Bladder / Q000601:surgery