title: Translumenal esophageal anastomosis for natural orifice translumenal endoscopic surgery: an ex vivo feasibility study.
abstract: OBJECTIVE
  This study aimed to develop a novel procedure for esophagoesophageal anastomosis for natural orifice translumenal endoscopic surgery (NOTES).
  
  
  METHODS
  An ex vivo feasibility study was performed in eight porcine models. The procedure was as follows: (1) A BraceBar™ (Olympus Medical Systems Corp., Tokyo, Japan), a double T-bar suturing device, was placed endoscopically at the blind end of the upper esophagus (UE). (2) The blind end was incised, and the scope was advanced out of the esophagus. (3) A balloon catheter was inserted into the lower esophagus (LE). (4) The catheter and a thread on the BraceBar were withdrawn so that the end of the UE was inverted, and the LE was pulled into the UE. (5) After the catheter was removed, a short tube was placed inside the duplicated part of the esophagus via the transgastric route. (6) A double ligature was performed using a ligating device over the tube. A liquid leak test was performed after the procedure.
  
  
  RESULTS
  All steps in this procedure were technically successful under the endoscopic visualization without any assistance from outside of the esophagus. The median time of this procedure was 31 (23-66) minutes. The median internal pressure of the UE was 122 (82-142) mm Hg when the anastomosed esophagus was separated into two specimens during the leak test.
  
  
  CONCLUSIONS
  Translumenal esophagoesophageal anastomosis was feasible. The duration of the procedure was short, and the anastomoses appear to have sufficient strength for use in clinical practice. An in vivo survival study is needed to confirm the safety and reliability of this NOTES procedure.
authors.affiliation: Department of Pediatric Surgery, The University of Tokyo Hospital, Tokyo, Japan. i-tetsuya@umin.ac.jp
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Ishimaru
authors.forename: Tadashi
authors.initials: T
authors.lastname: Iwanaka
authors.forename: Akira
authors.initials: A
authors.lastname: Hatanaka
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kawashima
authors.forename: Kan
authors.initials: K
authors.lastname: Terawaki
mesh_terms: D000714:Anastomosis, Surgical / Q000295:instrumentation / Q000379:methods; D000818:Animals; D004867:Equipment Design; D004947:Esophagus / Q000601:surgery*; D005240:Feasibility Studies; D057605:Natural Orifice Endoscopic Surgery / Q000295:instrumentation / Q000379:methods*; D013552:Swine