Endoscopic transesophageal access techniques

Interest in natural orifice translumenal endoscopic surgery (NOTES) within the thoracic cavity and the mediastinum is gaining momentum. The experience obtained from minimal invasive surgery suggests that the elimination of external incisions might potentially reduce the high morbidity of thoracic surgery associated with a thoracotomy and sternotomy by performing mediastinal and thoracic interventions through the esophagus. A variety of endoscopic transesophageal access techniques have been developed to approach mediastinal and thoracic structures such as full-thickness incision of the esophageal wall, submucosal tunneling, and endoscopic ultrasound-guided access. Initial experimental animal studies have shown that these NOTES techniques are feasible and potentially safe, opening a new arena for NOTES procedures, namely diagnostic and therapeutic mediastinoscopy and thoracoscopy. Potential adverse events during transesophageal NOTES procedures, such as bleeding, infection, and tension pneumomediastinum, as well as secure closure and healing of the esophageal incision are challenges to be addressed in future survival studies.