title: The lateral decubitus position improves transoral endoscopic access to the posterior aspects of the thorax.
abstract: BACKGROUND
  The success of natural orifice transluminal endoscopic surgery (NOTES) depends on an adequate exploration of surgical regions. Currently, limited data are available regarding the optimal position for the NOTES approach for thoracic surgery. This study therefore aimed to evaluate the effectiveness of transoral thoracic exploration in a canine model placed in a lateral decubitus position.
  
  
  METHODS
  A total of 14 dogs were used in this study. Transoral thoracoscopy was performed using a custom-made metal tube via an incision over the vestibular incision with the animal in a supine position. After thoracic exploration, the animal was placed in a lateral decubitus position. The thoracic intervention (surgical lung biopsy, pericardial window creation, and dorsal sympathectomy) was performed by passing a flexible bronchoscope through the lumen of a metal tube.
  
  
  RESULTS
  The mean operative time for this procedure was 70 min (range 45-100 min). For 12 dogs, all procedures were completed without major complications. However, for one dog, the exploration of the thoracic cavity was incorrect (the right lower lobe had been misinterpreted as the left lower lobe). Another dog had minor bleeding because of an intercostal artery injury that occurred during sympathectomy.
  
  
  CONCLUSIONS
  The posterior aspect of the thoracic cavity can be exposed via a transoral approach with the animal in a lateral decubitus position. This approach may be considered as an adjuvant to the supine approach, in which exploration of the posterior thoracic cavity is restricted.
authors.affiliation: Division of Genetics, Department of Pediatrics, Taipei Medical University Hospital, Taipei, Taiwan, ROC.
authors.forename: Chen
authors.initials: C
authors.lastname: Yang
authors.forename: Yen
authors.initials: Y
authors.lastname: Chu
authors.forename: Yi-Cheng
authors.initials: YC
authors.lastname: Wu
authors.forename: Ming-Ju
authors.initials: MJ
authors.lastname: Hsieh
authors.forename: Ming-Shian
authors.initials: MS
authors.lastname: Lu
authors.forename: Chieng-Ying
authors.initials: CY
authors.lastname: Liu
authors.forename: Hsu-Chia
authors.initials: HC
authors.lastname: Yuan
authors.forename: Yun-Hen
authors.initials: YH
authors.lastname: Liu
authors.forename: Po-Jen
authors.initials: PJ
authors.lastname: Ko
authors.forename: Hui-Ping
authors.initials: HP
authors.lastname: Liu
mesh_terms: D000818:Animals; D001706:Biopsy; D004285:Dogs; D008168:Lung / Q000473:pathology / Q000601:surgery; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods*; D061646:Operative Time; D010491:Pericardial Window Techniques; D011187:Posture; D013562:Sympathectomy / Q000379:methods; D019616:Thoracic Surgical Procedures / Q000379:methods*; D013906:Thoracoscopy / Q000379:methods*