Which parameters might predict complications after natural orifice endoluminal surgery (NOTES)? Results from a randomized comparison with open surgical access in pigs

Fritscher-Ravens, Annette; Ghanbari, Atefeh; Thompson, Sumner E.; Patel, K; Kahle, Erich; Fritscher, T; Niemann, Heiner; Koehler, P. Ruben; Milla, Peter J.

doi:10.1055/s-2007-966918

Cited by 13 publications

(6 citation statements)

References 14 publications

(14 reference statements)

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“…However, the transdigestive or transvaginal route is regarded to be a more contaminated site than the skin, and some studies have shown postoperative complications, such as intra-abdominal infection and leakage from access site, after transrectal NOTES procedures. 21,22 On the other hand, few studies have shown postoperative complications after NOTES procedures performed via transgastric, transvaginal, or transbladder access. [21][22][23][24] The transvaginal cholecystectomies performed in the present study also showed no intra-abdominal abscess or problems associated with the access site.…”

Section: Discussionmentioning

confidence: 99%

“…21,22 On the other hand, few studies have shown postoperative complications after NOTES procedures performed via transgastric, transvaginal, or transbladder access. [21][22][23][24] The transvaginal cholecystectomies performed in the present study also showed no intra-abdominal abscess or problems associated with the access site. These findings suggest that some problems still remain with transrectal access, whereas procedures performed via transgastric or transvaginal access appear to be relatively safe.…”

Section: Discussionmentioning

confidence: 99%

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

Suzuki

Yasuda

Kawaguchi

et al. 2010

Gastrointestinal Endoscopy

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

Suzuki

Yasuda

Kawaguchi

et al. 2010

Gastrointestinal Endoscopy

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“…Leucocyte count is reported to be a very sensitive marker for the identification of complications related to infection (29). In our study, total leucocyte counts were stable at T24 in all groups, indicating the absence of secondary infection during the experiment.…”

Section: Discussionmentioning

confidence: 99%

Acute inflammatory response to transgastric natural orifice transluminal endoscopic surgery peritoneoscopy: An experimental study in swine

Rezende¹,

Montero²,

Salomão³

et al. 2013

Clinics

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OBJECTIVE:To investigate the impact of transgastric peritoneal access on plasma biomarkers of acute inflammatory response in comparison to laparoscopy.METHODS:This was a prospective and comparative study in a porcine model. Transgastric peritoneal access performed by natural orifice transluminal endoscopic surgery was compared with laparoscopy. Laparotomy and sham groups were used as positive and negative controls, respectively. Thirty-four pigs were assigned to receive transgastric natural orifice transluminal endoscopic surgery (n = 12), laparoscopy (n = 8), laparotomy (n = 8) or a sham procedure involving only anesthesia (n = 6). In the natural orifice transluminal endoscopic surgery group, peritoneoscopy was performed with a gastroscope via transgastric access. Blood samples were collected at baseline and 1, 3, 6, 9 and 24 h after the surgical procedure for measurement of interleukins 1β, 6 and 10 and tumor necrosis factor-α. A complete blood count was performed, and C-reactive protein levels were measured at baseline and at 24 h.RESULTS:All surgical and endoscopic procedures were performed without major complications. Peritoneal cavity inventory showed no signs of peritonitis in any animal. Interleukin 1β, interleukin 10 and tumor necrosis factor-α levels were below the threshold of detection. The mean level of interleukin 6 was statistically significantly higher in the laparotomy group than in the other groups (p<0.05), with no significant differences among the sham, laparoscopy and natural orifice transluminal endoscopic surgery groups (p>0.05). C-reactive protein analysis indicated significant increases in all groups, with no differences among the groups. Complete blood count analysis showed no differences among the groups.CONCLUSIONS:Based on the observed interleukin 6 patterns, the systemic inflammatory response resulting from transgastric peritoneal access by natural orifice transluminal endoscopic surgery is similar in intensity to the response that occurs after laparoscopy.

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“…It remains to be seen whether the animal models can be successfully replicated in larger human studies. Hence, it is difficult to prove the benefits of NOTES when compared to conventional laparoscopic surgery (35).…”

Section: Pitfalls In Notes Adrenalectomymentioning

confidence: 99%

Adrenal natural orifice transluminal endoscopic surgery (NOTES): a step too far?

Salgaonkar

Parameswaran

2019

Gland Surg.

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Surgical approach to adrenal gland has evolved from open to minimally invasive surgery. With the advent of technology, multiple techniques and approaches are available in a surgeon's armamentarium today to deal with adrenal nodules that require surgical intervention. Each approach has its own advantages and disadvantages. The era of minimal invasive surgery has fuelled our quest for better cosmesis, faster recovery, early return to work and reduced hospital stay. While minimal invasive method is the preferred approach for most benign adrenal masses less than 6 cm, its application for large adrenal lesions as well as adrenocortical carcinoma is still debatable. Single incision minimal invasive procedures further try to reduce the incisions and wound morbidity. With the aim to completely remove visible scars and possibly reduced morbidity, the concept of natural orifice transluminal endoscopic surgery (NOTES) has been proposed by some surgeons as well as interventional gastroenterologist. In NOTES, the peritoneal cavity is accessed through a hollow viscus to perform therapeutic as well as diagnostic procedures. While the theoretical advantages of scar less surgery and its advantages sound encouraging, the precise indications and its potential advantages for adrenal pathologies is yet to be defined. It should in no way, compromise our goal of safe patient surgery and outcomes.

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Which parameters might predict complications after natural orifice endoluminal surgery (NOTES)? Results from a randomized comparison with open surgical access in pigs

Abstract: Animal behavior was a reliable indicator of severe complications. Fever, body weight, and the results of in vitro cultures of the peritoneal fluid did not indicate complications. WBC proved not to be specific but showed a larger increase in pigs with severe complications.

Cited by 13 publications

References 14 publications

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

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

Acute inflammatory response to transgastric natural orifice transluminal endoscopic surgery peritoneoscopy: An experimental study in swine

Adrenal natural orifice transluminal endoscopic surgery (NOTES): a step too far?

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