Abstract
Background
Anecdotal reports of natural orifice translumenal endoscopic surgery (NOTES) procedures in patients are emerging. Whether the new procedure truly is less invasive is not known. Perioperative hematologic parameters during NOTES was compared with those during standard laparoscopy.
Methods
For this study, 12 swine were randomized to transgastric peritoneoscopy with air or diagnostic laparoscopy using carbon dioxide. Arterial and venous catheters provided cardiopulmonary parameters and blood draws at baseline and up to 7 days postoperatively. The animals survived for 14 days. Data were analyzed by an investigator blinded to the procedure performed. Treatments were contrasted in terms of the mean outcome using a repeated measures linear model.
Results
All experiments were successfully completed. No gastric leak or peritonitis resulted. One NOTES animal died of hemorrhagic gastritis on postoperative day 3 due to bleeding distant from the gastrotomy site. Two animals in the laparoscopy group and one animal in the endoscopy group experienced respiratory compromise requiring disinflation. A widening pulse pressure and lower bladder pressure were observed in the NOTES group compared with the laparoscopy group (p < 0.001). Pre- and postoperative laboratory results showed an increase in the white blood cell count (1,000/ml) from 16.83 ± 1.94 in the laparoscopy group and 15.17 ± 0.41 in the NOTES group at baseline to 24.17 ± 3.25 and 23.33 ± 3.88, respectively, on postoperative day 7, but no difference between the groups (p = 0.6). The platelet count (1,000/ml) showed a difference between the two groups, changing from 422.5 ± 97.49 to 446.33 ± 89.86 in the laparoscopy group and from 368 ± 105 to 299.5 ± 161.9 in the NOTES group (p = 0.03).
Conclusion
Significant differences in measured but not clinically apparent parameters were encountered. A potentially significant thrombocytopenia clinically was encountered in the NOTES group. The physiologic impact of NOTES procedures beyond the absence of abdominal incisions should be investigated further.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Corrigan M, Cahill RA, Redmond HP (2007) The immunomodulatory effects of laparoscopic surgery. Surg Laparosc Endosc Percutan Tech 17:256–261
Hanly EJ, Aurora AA, Shih SP, Fuentes JM, Marohn MR, De Maio A, Talamini MA (2007) Peritoneal acidosis mediates immunoprotection in laparoscopic surgery. Surgery 142:357–364
Hochberger J, Lamade W (2005) Transgastric surgery in the abdomen: the dawn of a new era? Gastrointest Endosc 62:293–296
Ponsky JL (2005) Gastroenterologist as surgeons: what they need to know. Gastrointest Endosc 61:454
Kalloo AN, Singh VK, Jagannath SB, Niiyama H, Hill SL, Vaughn CA, Magee CA, Kantsevoy SV (2004) Flexible transgastric peritoneoscopy: a novel approach to diagnostic and therapeutic interventions in the peritoneal cavity. Gastrointest Endosc 60:114–117
Jagannath SB, Kantsevoy SV, Vaughn CA, Chung SS, Cotton PB, Gostout CJ, Hawes RH, Pasricha PJ, Scorpio DG, Magee CA, Pipitone LJ, Kalloo AN (2005) Peroral transgastric endoscopic ligation of fallopian tubes with long-term survival in a porcine model. Gastrointest Endosc 61:449–453
Kantsevoy SV, Jagannath SB, Niiyama H, Chung SS, Cotton PB, Gostout CJ, Hawes RH, Pasricha PJ, Magee CA, Vaughn CA, Barlow D, Shimonaka H, Kalloo AN (2005) Endoscopic gastrojejunostomy with survival in a porcine model. Gastrointest Endosc 62:287–292
Park PO, Bergstrom M, Ikeda K, Fritscher-Ravens A, Swain P (2005) Experimental studies of transgastric gallbladder surgery: cholecystectomy and cholecystogastric anastomosis (videos). Gastrointest Endosc 61:601–606
Bingener J, Michalek J, Winston J, Van Sickle K, Haines V, Lawrence V, Schwesinger W (2008) Randomized blinded trial comparing the cardiopulmonary effects of NOTES with standard laparoscopy in a porcine survival model. Surg Endosc 22:1430–1434
Rattner D, Kalloo A, ASGE/SAGES Working Group (2006) ASGE/SAGES Working Group on Natural Orifice Translumenal Endoscopic Surgery. October 2005. Surg Endosc 20:329–333 and Gastrointest Endosc 63:199–203
Jesmok G, Lindsey C, Duerr M, Fournel M, Emerson T Jr (1992) Efficacy of monoclonal antibody against human recombinant tumor necrosis factor in E. coli-challenged swine. Am J Pathol 141:1197–1207
Kim SS, Hwang JH, Choi CW, Shim JW, Chang YS, Park WS, Oh CK (2003) Detrimental effects of N(omega) nitro-L-arginine methyl ester (L-NAME) in experimental Escherichia coli sepsis in the newborn piglet. J Korean Med Sci 18:637–640
Naess F, Roeise O, Pillgram-Larsen J, Ruud TE, Stadaas JO, Aasen AO (1989) Plasma proteolysis and circulating cells in relation to varying endotoxin concentrations in porcine endotoxemia. Circ Shock 28:89–100
Bautista MJ, Ruiz-Villamor E, Salguero FJ, Sanchez-Cordon PJ, Carrasco L, Gomez-Villamandos JC (2002) Early platelet aggregation as a cause of thrombocytopenia in classical swine fever. Vet Pathol 39:84–91
Acknowledgment
The study was supported by a grant from the Society of American Gastrointestinal Endoscopic Surgeons (SAGES).
Author information
Authors and Affiliations
Corresponding author
Additional information
Presented at the 2nd international conference on NOTES, Boston, MA, 13–14 July, 2007.
Rights and permissions
About this article
Cite this article
Bingener, J., Michalek, J., Van Sickle, K. et al. Randomized blinded trial shows relative thrombocytopenia in natural orifice translumenal endoscopic surgery compared with standard laparoscopy in a porcine survival model. Surg Endosc 22, 2067–2071 (2008). https://doi.org/10.1007/s00464-008-0013-y
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-008-0013-y