Transoral endoscopic surgery versus conventional thoracoscopic surgery for thoracic intervention: safety and efficacy in a canine survival model.
OBJECTIVE
Transoral endoscopic surgery has been shown to be feasible and safe in both humans and animal models. The purpose of this study was to evaluate the safety and efficacy of transoral and conventional thoracoscopy for thoracic exploration, surgical lung biopsy, and pericardial window creation.


METHODS
The animals (n = 20) were randomly assigned to the transoral endoscopic approach group (n = 10) or conventional thoracoscopic approach group (n = 10). Transoral thoracoscopy was performed with a flexible bronchoscope via an incision over the vestibulum oris. In conventional thoracoscopy, access to the thoracic cavity was obtained through a thoracic incision. Surgical outcomes (body weight, operating time, operative complications, and time to resumption of normal diet), physiologic parameters (respiratory rate, body temperature), inflammatory parameters [white blood cell (WBC) counts and C-reactive protein (CRP)], and pulmonary parameters (arterial blood gases) were compared for both procedures.


RESULTS
The surgical lung biopsy and pericardial window creation were successfully performed in all animals except one animal in the transoral group. There was no significant difference in operating times between the groups. The increase in WBC in the transoral thoracoscopy group was significantly smaller on postoperative day 1 than in the conventional thoracoscopy group (p = 0.0029). The transoral group had an earlier return to preoperative body temperature (p = 0.041) and respiratory rate (p = 0.045) on day 7. With respect to pulmonary parameters, there was no significant difference in blood pH, pCO2, or PaCO2 between the transoral and transthoracic groups. All animals survived without complications 14 days after surgery.


CONCLUSIONS
This study demonstrated that the transoral approach was comparable to conventional thoracoscopic surgery for lung biopsy and pericardial window creation in terms of safety and efficacy.
Department of Thoracic Medicine, Chang Gung University, 5, Fushing Street, Gueishan Shiang, Taoyuan 333, Taiwan, ROC.
Chien-Ying
CY
Liu
Yen
Y
Chu
Yi-Cheng
YC
Wu
Hsu-Chia
HC
Yuan
Po-Jen
PJ
Ko
Yun-Hen
YH
Liu
Hui-Ping
HP
Liu
D000818:Animals; D001706:Biopsy / Q000379:methods; D001831:Body Temperature; D002097:C-Reactive Protein / Q000032:analysis; D002245:Carbon Dioxide / Q000097:blood; D004285:Dogs; D006863:Hydrogen-Ion Concentration; D007958:Leukocyte Count; D008168:Lung / Q000473:pathology; D023421:Models, Animal; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods*; D061646:Operative Time; D010491:Pericardial Window Techniques; D011184:Postoperative Period; D011897:Random Allocation; D056152:Respiratory Rate; D013906:Thoracoscopy
D002245:Carbon Dioxide; D002097:C-Reactive Protein