title: Feasibility of transumbilical surgical lung biopsy and pericardial window creation.
abstract: BACKGROUND
  To date there are no practical platforms for performing natural orifice transluminal endoscopic surgery in the thoracic cavity. This study evaluates the feasibility of transumbilical thoracosopy for lung biopsy and pericardial window creation.
  
  
  METHODS
  Eleven dogs (6 in the nonsurvival group and 5 in the survival group) were used for this study. A homemade metallic tube was advanced into the abdominal cavity via a 12-mm umbilical incision. The metallic tube was advanced into the thoracic cavity through a subxyphoid diaphragmatic incision under video guidance. Access to the thoracic cavity was achieved by a flexible bronchoscope via the metallic tube. Surgical lung biopsy and pericardial window creation were performed using an electrocautery loop and needle knife. The animals were euthanized 20 minutes after the surgery was complete (nonsurvival group) or 14 days postsurgery (survival group) for necropsy evaluation.
  
  
  RESULTS
  Eight pericardial window creations and 21 of 22 preplanned lung biopsies were completed in a median time of 72.18 minutes (range 50-105 minutes). One dog in the nonsurvival group died after tension pneumothorax due to postprocedure massive air leaks. In the survival group, the postoperative period was uneventful in all 5 dogs. Autopsies revealed no signs of vital organ injury and complete healing of the diaphragmatic incision occurred in all animals.
  
  
  CONCLUSIONS
  The study demonstrated that transumbilical thoracoscopic surgical lung biopsy and pericardial window creation is feasible. The safety and efficacy of the transumbilical approach need to be verified by a more detailed survival study.
authors.affiliation: 1Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Yi-Cheng
authors.initials: YC
authors.lastname: Wu
authors.lastname: Yen-Chu
authors.forename: Chi-Ju
authors.initials: CJ
authors.lastname: Yeh
authors.forename: Ming-Ju
authors.initials: MJ
authors.lastname: Hsieh
authors.forename: Tzu-Ping
authors.initials: TP
authors.lastname: Chen
authors.forename: Ying-Kai
authors.initials: YK
authors.lastname: Chao
authors.forename: Ching-Yang
authors.initials: CY
authors.lastname: Wu
authors.forename: Hsu-Chia
authors.initials: HC
authors.lastname: Yuan
authors.forename: Po-Jen
authors.initials: PJ
authors.lastname: Ko
authors.forename: Yun-Hen
authors.initials: YH
authors.lastname: Liu
authors.forename: Hui-Ping
authors.initials: HP
authors.lastname: Liu
mesh_terms: D000818:Animals; D001706:Biopsy / Q000379:methods*; D001999:Bronchoscopy; D004285:Dogs; D005240:Feasibility Studies; D008168:Lung / Q000601:surgery*; D023421:Models, Animal; D057605:Natural Orifice Endoscopic Surgery; D010491:Pericardial Window Techniques; D015996:Survival Rate; D014472:Umbilicus
keywords: NOTES; SILS/single site surgery; flexible endoscopy