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Minimally Invasive Surgery
Volume 2012, Article ID 365814, 6 pages
Research Article

Natural Orifice Translumenal Endoscopic Surgery for Anterior Spinal Procedures

1Division of Gastroenterology and Hepatology, University of Puerto Rico School of Medicine, San Juan, PR 00936, USA
2Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, 600 N. Wolfe Street, Blalock 465, Baltimore, MD 21287, USA
3Department of Surgery, University of Puerto Rico School of Medicine, San Juan, PR 00936, USA
4Department of Digestive Diseases, Lariboisière Hospital, AP-HP, Paris, France

Received 16 October 2011; Revised 26 December 2011; Accepted 27 March 2012

Academic Editor: Silvana Perretta

Copyright © 2012 Priscilla Magno et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Background. NOTES techniques allow transesophageal access to the mediastinum. The aim of this study was to assess the feasibility of transesophageal biopsy of thoracic vertebrae. Methods. Nonsurvival experiments on four 50-kg porcine animals were performed. Transesophageal access to the mediastinum was attained using submucosal tunneling technique. Results. The posterior mediastinum was successfully accessed and navigated in all animals. Vertebral bodies and intervertebral spaces were easily approached while avoiding damage to adjacent vessels. Bone biopsy was successfully performed without complications, but the hardness of bone tissue resulted in small and fragmented samples. Conclusions. Peroral transesophageal access into the posterior mediastinum and thoracic vertebral bone biopsy was feasible and safe. The proximity of the esophagus to the vertebral column provides close and direct access to the thoracic spine and opens up new ground for the performance of multilevel anterior spine procedures using NOTES techniques.