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Randomized trial on the physiologic impact of NOTES

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Abstract

Background

Our previous work revealed significantly less acidosis in swine undergoing natural orifice translumenal endoscopic surgery (NOTES) using endoscopic air insufflation than swine undergoing standard laparoscopy. We wanted to evaluate the differential effects of CO2 versus intra-abdominal pressure as source for this finding. In addition, we investigated the endocrine stress response between swine undergoing NOTES peritoneoscopy with CO2 insufflation and animals undergoing standard diagnostic laparoscopy with CO2.

Materials and methods

Twenty-eight (28) female 50-kg domestic pigs were randomly assigned to one of four groups using a permuted block randomization table: Group 1: NOTES using CO2 insufflation, Group 2: NOTES using air insufflation, Group 3: laparoscopy max pressure 12 mmHg and Group 4: laparoscopy with max pressure 7 mmHg. Invasive monitoring lines were placed. Pneumoperitoneum was established by the respective method and maintained for 90 min, visualizing liver, spleen and colon. Arterial blood gas was obtained at baseline and four additional time points. Serum TNF-α for POD (postoperative day) 1 and cumulative urine adrenaline for the procedure were determined by ELISA. ANOVA and t test were used for statistical comparison. The study was Institutional Animal Care and Use Committees approved.

Results

All experiments were completed as outlined. Blood pH showed a significant difference between groups. Serum TNF-α revealed higher levels for NOTES CO2 on POD 1 than standard laparoscopy (p = 0.03).

Conclusion

NOTES animals with CO2 insufflation initially experienced similar pH compared to standard laparoscopy but recovered to levels seen in low-pressure laparoscopy and NOTES with air. NOTES with CO2 appears to elicit a stronger stress response in this study than standard or low-pressure laparoscopy or NOTES with air.

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Acknowledgments

Research reported in this manuscript was funded through a NOSCAR grant (Natural Orifice Surgery Consortium for Assessment and Research) and in part by the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health under award number K23DK93553. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Disclosures

Juliane Bingener: Surgeon Advisory Board, Titan Medical Inc. Erica Loomis, Marianne Huebner and Christopher Gostout: None.

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Authors and Affiliations

  1. Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    Juliane Bingener & Erica A. Loomis

  2. Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA

    Christopher J. Gostout

  3. Department of Statistics and Probability, Michigan State University, East Lansing, MI, USA

    Marianne Huebner

Authors
  1. Juliane Bingener
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  2. Erica A. Loomis
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  3. Marianne Huebner
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  4. Christopher J. Gostout
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Correspondence to Juliane Bingener.

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Bingener, J., Loomis, E.A., Huebner, M. et al. Randomized trial on the physiologic impact of NOTES. Surg Endosc 29, 3551–3558 (2015). https://doi.org/10.1007/s00464-015-4106-0

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  • DOI: https://doi.org/10.1007/s00464-015-4106-0

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