Evaluation of the clinical and inflammatory responses in exclusively NOTES transvaginal cholecystectomy versus laparoscopic routes: an experimental study in swine
The aim of this study was to evaluate the clinical and inflammatory responses to surgical trauma caused by the natural orifice transluminal endoscopic surgery (NOTES) transvaginal endoscopic procedure compared with those of the laparoscopic route.
Twenty-one female swine were divided into three groups of seven animals and subjected to cholecystectomy using laparoscopic, laparotomic, and exclusively NOTES transvaginal routes. A group of five animals served as a control. The animals were monitored during surgery to evaluate anesthetic/surgical time and the presence of complications, which were evaluated after surgery with respect to roaming time, feeding, and the presence of clinical occourrence Measurements of TNF-α, IL-1β, IL-6, CRP, IFN-γ were obtained before and after surgery, on the second and seventh postoperative days, and when the animals were killed and necropsied.
All procedures were successfully completed as proposed in each group. Perioperative complications consisted of only gallbladder perforation and hepatic bleeding. The anesthetic/surgical time was longer in the NOTES vaginal group (p < 0.001). The postanesthetic recovery time, roaming, nutrition, and clinical evolution were similar in all groups. IL-1β and IL-6 were undetectable in all groups. Levels of TNF-α, CRP, and IFN-γ were similar among the groups. However, the evolution of the inflammatory process, measured as the difference between the peak dose and the basal dose of IFN-γ, was lower in the NOTES group than in the laparotomy group. In the necropsy findings, only adhesions were found, with no difference among the groups.
The entirely NOTES transvaginal cholecystectomy was feasible and safe. The surgical time was greater for the NOTES vaginal route. The inflammatory response was similar among the groups based on the levels of CRP and IFN-γ. However, the evolution of the inflammatory process seems to have been shorter in the vaginal NOTES group than in the laparotomy group as demonstrated by the difference between the peak and basal doses of IFN-γ.
KeywordsCholecystectomy Endoscopic Transluminal Inflammation Cytokines NOTES
The authors are grateful to Research Support Foundation of the State of São Paulo, which has funded this research; to the Experimentation and Training Center for Experimental Surgery of Albert Einstein Israelite Hospital, São Paulo, especially to the veterinarian Valéria Chiba, for the technical support toward this research; to Salomão & Zopi Diagnostic Medicine Laboratory, São Paulo, namely, Drs. Gianfranco Zampieri and Patrícia Udiloff for their assistance with cytokine dosage; and to the Surgical Gastroenterology Graduate Program of the Federal University of São Paulo for the scientific support throughout the preparation of this work.
Josiel P. Vieira, Marcelo M. Linhares, Elesiário M. Caetano Jr., Rita M. A. Moura, Vitor Asseituno, Rogério Fuzyi, Manoel J. B. Girão, José M. Ruano, Alberto Goldenberg, Gaspar de Jesus L. Filho, and Délcio Matos have no conflicts of interest or financial ties to disclose.
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