Cardiopulmonary and immunologic effects of transvaginal natural-orifice transluminal endoscopic surgery cholecystectomy compared with laparoscopic cholecystectomy in a porcine survival model

Inflammatory impact of NOTES peritoneoscopy is not different from that of laparoscopy: a randomized comparative study in a survival porcine model

“…Chemical irritants are less important at the vagina, and sterilization of this area is easier than in the stomach or the colon. This might explain the low inflammatory impact observed with this approach, as previously suggested [30]. CO 2 insufflation was used in all groups due to its modulatory effects on the inflammatory response during NOTES and laparoscopic surgery [35,36].…”

“…Second, we were not able to detect plasma levels of IL-1b and IL-6 in the majority of specimens. A more complex surgery might increase the inflammatory response, making possible the analysis of these parameters, as seen in previous studies [29,30]. Finally, pneumoperitoneum and anesthesia times were different among the groups and could have modified the inflammatory response.…”

“…We found the transrectal access to be the most invasive approach and the vaginal access the least invasive. In fact, a very recent study comparing transvaginal and laparoscopic cholecystectomy showed lower levels of TNFa in the NOTES group at the first day after surgery [30]. Prior animal [22,23] and human [24] studies that compared laparotomy with laparoscopy demonstrated that the peritoneal fluid harbors a higher concentration of cytokines, which provides a more accurate assessment of the local inflammatory response.…”

“…The premise that NOTES is less invasive than laparoscopy has not yet been demonstrated [26][27][28][29][30]. In addition, the available data evaluating transgastric access to the peritoneal space is limited and other routes have not been extensively investigated.…”

“…Several studies have analyzed the inflammatory response of transgastric NOTES and compared it with laparoscopy and laparotomy, with conflicting results [26][27][28][29]. Very recently, transvaginal cholecystectomy has been shown to preserve immune function similarly to laparoscopic cholecystectomy [30,31]. However, transcolonic access has not been adequately studied [32].…”