ABSTRACT
The field of endoscopic esophageal surgery is based on the concept of natural orifice transluminal endoscopic surgery (NOTES). Submucosal space surgery or third space surgery with the use of flexible endoscopy allows for decreased morbidity and hospital length of stay with equivalent outcomes for patients. In the case of achalasia, per oral endoscopic myotomy (POEM) allows for management of refractory cases in setting of previous Heller Myotomy or in patients whom laparoscopic or thoracoscopic surgery is contraindicated. Lastly, POEM more directly divides circular muscular layer of esophagus without destroying surrounding structures that exist to prevent reflux. The innovations in endoscopic surgery began in the animal lab with experiments in the porcine model to develop a way to access the peritoneal cavity through an entry point in the gastric mucosa. Over the last 10 years, the biggest treatment innovations in endoscopy have focused on management of achalasia with the use of POEM. POEM became possible as technology was developed that revolutionized the use of flexible technology and the methods of mucosal closure. In addition to benign esophageal disease, endoscopic methods improved in management of esophageal malignancy with endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD). The innovations of endoscopic surgery have been developed through the utilization of the submucosal space as a method to ensure adequate closure of the mucosal entry point into the peritoneal cavity. The goal of this review paper is to explore POEM and other techniques in endoscopic esophageal surgery for the management of esophageal diverticulum, submucosal tumors, gastroparesis, and gastrointestinal esophageal reflux disease.
ABSTRACT
Peritoneopericardial diaphragmatic hernia is a rare entity involving herniation of abdominal viscera through the diaphragm into the pericardial sac. It is most often seen after blunt abdominal trauma, but can occur following any trans-diaphragmatic intervention. We report on a 56-year-old female with peritoneopericardial diaphragmatic hernia secondary to a convergent procedure for the treatment of atrial fibrillation, who underwent a laparoscopic repair. An anterior abdominal wall laparoscopic approach was employed. Transverse colon and greater omentum were within the hernia sac. The defect measuring 3 cm × 3 cm was repaired using a composite hernia mesh. The total operative time was 78 minutes. No intra-operative and no post-operative complications were observed. Patient remained asymptomatic at a 6-month follow-up. Laparoscopic mesh repair of peritoneopericardial diaphragmatic hernia is safe, feasible and is the procedure of choice for treating these complex hernias.
ABSTRACT
The present study examined a visual field asymmetry in the contingent capture of attention that was previously observed by Du and Abrams (2010). In our first experiment, color singleton distractors that matched the color of a to-be-detected target produced a stronger capture of attention when they appeared in the left visual hemifield than in the right visual hemifield. This replicated Du and Abrams and also revealed a difference between hemifields in the time course of this effect. Our second experiment suggested that this asymmetry is moderated by the tuning of attentional control settings: when the target was easier to detect the asymmetry was attenuated. Our third experiment showed that this asymmetry is also present during singleton detection: a color singleton distractor produced a larger capture effect in the left hemifield than in the right hemifield. Finally, our fourth experiment suggested that this asymmetry is moderated by the salience of the attention-capturing distractor: when the distractor was not salient, the asymmetry was attenuated. These results suggest that there are boundary conditions in the observed hemifield asymmetry in the contingent capture of attention and several underlying brain systems might be involved.
