Zero-Incision Resection of a Posterior Mediastinal Mass: Transesophageal NOTES at Peking University Third Hospital

[Diagnostic Dilemma]

🔬 A 25-year-old female presented with an incidentally discovered 3 cm posterior mediastinal mass.

🩸 The lesion was situated immediately adjacent to the esophagus and major mediastinal vessels.

💡 Conventional open or thoracoscopic approaches would induce substantial surgical stress and prolonged recovery for a benign-appearing cyst.

[Surgical Nuances]

👨⚕️ The gastroenterology team at Peking University Third Hospital opted for a transesophageal Natural Orifice Transluminal Endoscopic Surgery (NOTES) approach.

🛠️ As illustrated in the attached schematic, a submucosal tunnel was created within the esophageal wall.

🔪 A precise 1.5 cm myotomy was performed through the muscularis propria to access the posterior mediastinum directly.

👁️ The endoscopic views demonstrate the meticulous dissection required to free the mass from the dense surrounding vascular and neural networks.

[Clinical Pearls]

⏱️ The entire en bloc resection was completed in under 60 minutes.

🧬 The mucosal entry site was securely closed using metallic clips to ensure a zero-incision recovery.

📊 Postoperative imaging, as seen in the attached CT scans, confirms complete clearance of the bronchogenic cyst with excellent anatomical restoration.

[Take-home Message]

📌 Transesophageal NOTES offers a highly precise and minimally invasive anatomical route for posterior mediastinal lesions.

🏥 It significantly reduces physiological burden while achieving definitive curative outcomes.