TY - JOUR
T1 - Assessing the invasiveness of NOTES perforated viscus repair
T2 - A comparative study of NOTES and laparoscopy
AU - Moran, E. A.
AU - Gostout, C. J.
AU - McConico, A. L.
AU - Michalek, J.
AU - Huebner, M.
AU - Bingener, Juliane
PY - 2012/1
Y1 - 2012/1
N2 - Background Natural orifice transluminal endoscopic surgery (NOTES) repair of perforated peptic ulcers may decrease surgical invasiveness and improve patient outcomes. Methods Full thickness gastrotomy was created laparoscopically in swine followed by soilage time. Repair proceeded with a laparoscopic (n = 14) or the NOTES (n = 14) approach. For NOTES repair, the omentum was endoscopically pulled into the gastric lumen and clipped. Intraoperative and postoperative parameters were recorded, including arterial blood gas (ABG) analysis and serum samples for white blood cell (WBC), TNF-α, IL-1, and IL-6 analysis. Results Twenty-four of 28 animals thrived to study completion. NOTES repair could not be accomplished in one animal. At necropsy, all repairs were intact. Blood pressure was equivalent between groups. Pulse examined during the last 30 min of each procedure revealed a slightly higher mean pulse in the animals undergoing NOTES procedures (NOTES, 102 ± 28; laparoscopy, 83 ± 24). ABG obtained at the conclusion of the procedure revealed a pH of 7.47 in NOTES animals and 7.43 in the laparoscopy animals (p = 0.06), a change from baseline in both groups. The final pCO2 was lower in the NOTES group (NOTES, 40.62; laparoscopy, 47.49, p = 0.03). WBC counts were comparable on postoperative day (POD) 1 (NOTES, 21.1; laparoscopy, 19.0; p = 0.49). Mean TNF-α serum levels were equivalent at all time points between groups; however, TNF-α varied significantly from baseline to POD 7 (p = 0.002). Conclusion NOTES omental repair appears comparable to that of laparoscopy. The lower arterial pCO2 at the conclusion of the NOTES procedure may be advantageous in critically ill patients.
AB - Background Natural orifice transluminal endoscopic surgery (NOTES) repair of perforated peptic ulcers may decrease surgical invasiveness and improve patient outcomes. Methods Full thickness gastrotomy was created laparoscopically in swine followed by soilage time. Repair proceeded with a laparoscopic (n = 14) or the NOTES (n = 14) approach. For NOTES repair, the omentum was endoscopically pulled into the gastric lumen and clipped. Intraoperative and postoperative parameters were recorded, including arterial blood gas (ABG) analysis and serum samples for white blood cell (WBC), TNF-α, IL-1, and IL-6 analysis. Results Twenty-four of 28 animals thrived to study completion. NOTES repair could not be accomplished in one animal. At necropsy, all repairs were intact. Blood pressure was equivalent between groups. Pulse examined during the last 30 min of each procedure revealed a slightly higher mean pulse in the animals undergoing NOTES procedures (NOTES, 102 ± 28; laparoscopy, 83 ± 24). ABG obtained at the conclusion of the procedure revealed a pH of 7.47 in NOTES animals and 7.43 in the laparoscopy animals (p = 0.06), a change from baseline in both groups. The final pCO2 was lower in the NOTES group (NOTES, 40.62; laparoscopy, 47.49, p = 0.03). WBC counts were comparable on postoperative day (POD) 1 (NOTES, 21.1; laparoscopy, 19.0; p = 0.49). Mean TNF-α serum levels were equivalent at all time points between groups; however, TNF-α varied significantly from baseline to POD 7 (p = 0.002). Conclusion NOTES omental repair appears comparable to that of laparoscopy. The lower arterial pCO2 at the conclusion of the NOTES procedure may be advantageous in critically ill patients.
KW - NOTES
KW - Natural orifice transluminal endoscopic surgery
KW - Omental patch
KW - Omental plug
KW - Perforated peptic ulcer disease
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U2 - 10.1007/s00464-011-1834-7
DO - 10.1007/s00464-011-1834-7
M3 - Article
C2 - 21792716
AN - SCOPUS:84857421770
SN - 0930-2794
VL - 26
SP - 103
EP - 109
JO - Surgical endoscopy
JF - Surgical endoscopy
IS - 1
ER -