Comparison of Hemodynamic and Inflammatory Changes between Transoral and Transthoracic Thoracoscopic Surgery

Abstract

BackgroundNatural orifice transluminal endoscopy has been developed for abdominal surgical procedures. The aim of this study was to compare the surgical outcome between a novel transoral approach and a standard transthoracic approach for the thoracic cavity in a canine model.MethodsTwenty-eight dogs were assigned to transoral (n = 14) or standard thoracoscopy (n = 14). Each group underwent thoracic exploration, pre-determined surgical lung biopsy, and pericardial window creation. Blood draws were obtained before surgery and at postoperative days 1, 3, 7, and 14. Operative time, complications, laboratory parameters, hemodynamic parameters, and inflammatory parameters were compared between the two procedures. The animals were monitored for two weeks and necropsy were performed for surgical outcome evaluation.ResultsThe thoracic procedures were successfully performed in all of the dogs, with the exception of one animal in the transoral group. There were no serious acute or delayed complications related to surgery. There was no difference between the two surgical groups for each of the hemodynamic parameters that were evaluated. Regarding the immunological impact of the surgeries, transoral thoracoscopy was associated with significant elevations in interleukin 6 and c-reactive protein levels on postoperative days 1 and 3, respectively, when compared with the standard thoracoscopy. All dogs recovered well, without signs of mediastinitis or thoracic infection. Necropsy revealed absence of infection, no injury to vital organs, and confirmed the success of the novel procedure.ConclusionsThis study suggests that both techniques were comparable with respect to procedure success rate, hemodynamic impact, and inflammatory changes. Furthermore, there was no difference in the incidence of postoperative discomfort between groups.

C-reactive protein: quantitative marker of surgical trauma and post-surgical complications in dogs: a systematic review

“…Minimizing tissue trauma and subsequent stress response is a goal of surgery [ 42 ] and CRP is often included as an objective marker in studies investigating this response in dogs [ 37 , 42 , 43 , 45 ]. CRP has on several occasions been used in studies investigating new surgical procedures for the veterinary clinic [ 26 , 29 , 31 , 35 ], in studies using dogs as model for human disease [ 27 , 28 , 30 ], and in studies comparing different surgical procedures [ 32 , 34 ]. In the last group several studies have compared surgical trauma by comparing different surgical procedures in different tissues [ 9 , 33 ].…”

“…One study has, however, shown significant lower concentrations of CRP as a result of treatment with low doses of ketamine during and after surgery [ 40 ], as also demonstrated in humans [ 51 ]. Ketamine was included in the anesthetic protocols of 6 studies included in the review [ 22 , 27 , 28 , 32 , 34 , 41 ], and CRP concentrations in these studies could potentially be affected when compared to the remaining studies. However, other studies in human medicine have shown conflicting results [ 52 , 53 ] and the conclusions for dogs were all based on a single study affected by considerable risks of bias (Fig.…”

Increased ischemia-modified albumin and malondialdehyde levels in videothoracoscopic surgery

“…[ 4 ] Moreover, a decrease is observed in end-diastolic pressure and arterial pressure, as well. [ 5 ] CO 2 infusion is applied into intrapleural cavity and lungs are collapsed during this operation. Changes are observed in lung function tests, and these changes prolong until postsurgical 2 weeks period.…”