Submucosal endoscopy with mucosal flap safety valve (SEMF) technique: A safe access method into the peritoneal cavity and mediastinum

Kazuki Sumiyama, Hisao Tajiri, Christopher J. Gostout

Research output: Contribution to journalReview article

29 Scopus citations

Abstract

Natural orifice translumenal endoscopic surgery (NOTES) is a unique emerging surgical concept expanding flexible endoscopy beyond the gut wall. The methods and technology growing from this concept may minimize trauma from surgical access to the peritoneal cavity by completely eliminating body surface incisions. Our colleagues at the Mayo Clinic have explored, over several years, the concept of using the submucosa as a working space for endoscopic interventions, such as resection of mucosal neoplasias and submucosal tumors, as well as for the acquisition of muscular tissue for etiologic analysis of motility disorders. The submucosal space can also be utilized as a protective tunnel preventing peritoneal soiling by using the free overlying mucosa, as a sealant flap, and permitting a safer offset entry into the peritoneal and thoracic cavities for NOTES. In the SEMF technique, the submucosal space is mechanically created by balloon dissection facilitated by either high-pressure CO2 gas injection or chemically 'softening' the submucosal connective tissues. This article reviews and describes SEMF in detail along with applications involving in vivo porcine models.

Original languageEnglish (US)
Pages (from-to)365-369
Number of pages5
JournalMinimally Invasive Therapy and Allied Technologies
Volume17
Issue number6
DOIs
StatePublished - Dec 5 2008

Keywords

  • Natural Orifice Translumenal Endoscopic Surgery (NOTES)
  • Submucosal endoscopy with mucosal flap safety valve (SEMF)
  • Transesphageal access to the thoracic cavity
  • Transgastric access to the peritoneal cavity

ASJC Scopus subject areas

  • Surgery

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