Natural orifice transluminal endoscopic mediastinal surgery: NOTEMS, a promising field for endotherapy.

Dissect the surrounding tissues as close as possible to the tumor capsule but still with the aim of achieving en bloc resection. e Step 4: Tumor extraction. Incise the esophageal wall layer by layer from the mucosa, submucosa to muscularis, and expose the tumor in the mediastinal cavity, then extend the incision along the vertical diameter of the tumor to ensure the tumor can be removed smoothly. d Step 3: Tumor dissection. Locate the tumor site and perform a submucosal injection followed by a 2-cm longitudinal mucosal incision made right above the tumor site. c Step 2: Full-thickness resection of the esophageal wall. [Extracted from the article]