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. 2020 Mar;12(3):1022–1030. doi: 10.21037/jtd.2020.01.15

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2020 Journal of Thoracic Disease. All rights reserved.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0.

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Endovac therapy is based on principles of applying suction to a cavity to allow for granulation tissue to form and thus allow closure of the cavity from inside-out. Left most panel (a, e, g): the apparatus is rather simple and uses a nasogastric tube (NGT) sutured to a black sponge. Reprinted with permission of Dr. Nathan R. Smallwood, Texas Oncology, Sherman, TX and SAGES. Middle panel (b, f): after visualizing the defect, the cavity is cleaned and irrigated. An NGT is passed via the nares and pulled out through the mouth. It is then sutured to a sponge, which is then directed into appropriate place using the endoscope. Negative suction is applied once in position. Reprinted from ANZ Journal of Surgery 2016 with permission granted by John Wiley and Sons. Right most panel (c, d, h, i, j): various mechanisms have been proposed to explain the healing of the leaking bed. Reprinted with permission of Dr. Damien Loh, Melbourne Gastro Oesophageal Surgery, Australia.