Review Article

Natural Orifice Transesophageal Endoscopic Surgery: State of the Art

Figure 1

Transesophageal submucosal endoscopy with mucosal flap (SEMF) in a porcine model. (a) Saline is injected into the submucosal layer of the esophagus. (b) The mucosa of the bleb is incised using a needle knife. (c) A 10 cm tunnel is created using air and blunt dissection. The muscularis propria is incised at the distal end of the esophageal submucosal tunnel. (d) The endoscope is passed through the esophagotomy and the thoracic cavity is inspected. (e) Esophagotomy closure is achieved by mucosal flap adhesion. The mucosal defect is sutured using endoclips.
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