title: Pilot study of transesophageal endoscopic surgery: NOTES esophagomyotomy, vagotomy, lymphadenectomy.
abstract: OBJECTIVE
  The aim of this study was to evaluate the technical feasibility of endosonographically-assisted transesophageal access for vagotomy, esophagomyotomy, and lymphadenectomy in a nonsurvival study with six porcine models in an animal laboratory with general anesthesia.
  
  
  METHODS
  Saline/hydroxypropylmethylcellulose (HPMC) was injected into the submucosa with a subsequent biliary balloon dissection, creating a substantial submucosal space for a cap-fitted endoscope. A distal esophageal myotomy was performed after access into the thoracic cavity. Over the course of 6 pigs, esophagomyotomy (simulating a Heller myotomy), vagotomy, and lymphadenectomy were performed. The esophageal insertion/access site was sealed by the flap of mucosa.
  
  
  RESULTS
  Using a midesophageal entrance point, successful thoracic access and therapeutic interventions involving the esophagus and periesophageal structures were performed in 6 pigs.
  
  
  CONCLUSIONS
  The submucosal saline/HPMC tunneling technique allowed for successful access to the upper mediastinum through the esophagus with feasible therapeutic interventions.
authors.affiliation: Department of Medicine, Mayo Clinic, Jacksonville, Florida 32224, USA. woodward.Timothy@mayo.edu
authors.forename: Timothy
authors.initials: T
authors.lastname: Woodward
authors.forename: David
authors.initials: D
authors.lastname: McCluskey
authors.forename: Michael B
authors.initials: MB
authors.lastname: Wallace
authors.forename: Massimo
authors.initials: M
authors.lastname: Raimondo
authors.forename: John
authors.initials: J
authors.lastname: Mannone
authors.forename: C Daniel
authors.initials: CD
authors.lastname: Smith
mesh_terms: D000818:Animals; D019160:Endosonography; D004945:Esophagoscopy / Q000379:methods*; D005240:Feasibility Studies; D065347:Hypromellose Derivatives; D008197:Lymph Node Excision / Q000379:methods*; D008481:Mediastinoscopy / Q000379:methods*; D008482:Mediastinum / Q000601:surgery*; D008747:Methylcellulose / Q000008:administration & dosage / Q000031:analogs & derivatives; D010865:Pilot Projects; D012965:Sodium Chloride / Q000008:administration & dosage; D013552:Swine; D014628:Vagotomy / Q000379:methods*
chemical_list: D065347:Hypromellose Derivatives; D012965:Sodium Chloride; D008747:Methylcellulose