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85th Annual Meeting of the German Society of Oto-Rhino-Laryngology, Head and Neck Surgery

German Society of Oto-Rhino-Laryngology, Head and Neck Surgery

28.05. - 01.06.2014, Dortmund

Transoral Endoscopic Mediastinal Surgery (TOEMS): results of a initial proof-of-concept study

Meeting Abstract

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  • corresponding author presenting/speaker Thomas Wilhelm - Dept. Otolaryngology, Kliniken Leipziger Land, Borna, Germany
  • author Wolfram Klemm - Dept. Thoracic Surgery, Evangelische Lungenklinik, Berlin, Germany
  • author Andrè Nemat - Dept. Thoracic Surgery, HELIOS Klinikum, Wuppertal, Germany

German Society of Oto-Rhino-Laryngology, Head and Neck Surgery. 85th Annual Meeting of the German Society of Oto-Rhino-Laryngology, Head and Neck Surgery. Dortmund, 28.05.-01.06.2014. Düsseldorf: German Medical Science GMS Publishing House; 2014. Doc14hno05

doi: 10.3205/14hno05, urn:nbn:de:0183-14hno053

Published: July 24, 2014

© 2014 Wilhelm et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Introduction: TOEMS utilizes the vesibule and floor of mouth as a natural orifice for an endoscopic minimal invasive approach for surgical procedures within the mediastinum. Anatomical and anaimal studies proofed the feasibility and safety of the method. In this study we applied the technique in patients with suspect lymph nodes within the mediastinum. Aim in this proof-of-concept study was the accessability and resectabiltiy of pathological changes within the mediastinum.

Methods: In 10 patients we placed an optical scissor through a trocar placed sublingually in the midline in the pretracheal region and created by two additional trocars in the vestibule of mouth with 2.7 mm standard laparoscopic intruments and by means of a CO2-insufflation (6–10 mmHg) a working space. The anterior wall of the trachea was visualized below the thyroid isthmus and the mediastinum enterd along the trachea. Pathological enlarged lymph nodes were spearated under direct endospic vision and preparation of related anatomical structures. All patients have had a nasotracheal intubation and a neuromonitoring of the recurrent laryngel nerve (RLN) was applied. The postoperative course was evaluated according to standardized protocol.

Results: In all cases the intended region within the mediastinum could be reached and lymph node tissue could be harvested. In 2 cases a conversion to a conventional video-mediastinoscopy was necessary (1 x tension pneumothorax, 1 x correct layer couldn’t be detected). We noticed one permanet RLN-palsy on the right side. Minor complications like small superficial haematoms, peroral paraesthesia or cervical emphysema resolved completely within 2 to 3 weeks.

Conclusion: The transoral endoscopic and minimal invasive access is feasible for a surgical approach and procedures within the mediastinum. A resection of pathological changes is possible. For a further evaluation regarding the effectiveness of the method a prospective comparative study of TOEMS versus conventional video-mediastinoscopy is mandatory.