Natural orifice versus conventional laparoscopic distal pancreatectomy in a porcine model: a randomized, controlled trial.
BACKGROUND
Natural orifice transluminal endoscopic surgery (NOTES) research has primarily involved case series reports of low-risk procedures. Distal pancreatectomy has significant postoperative morbidity and would permit rigorous examination in a controlled trial setting.


OBJECTIVE
To compare endoscopic transgastric distal pancreatectomy (ETDP) and laparoscopic distal pancreatectomy (LDP).


METHODS
Prospective, randomized, controlled trial.


METHODS
Academic hospital.


METHODS
Forty-one swine, 28 block randomized.


METHODS
LDP was performed with 3 trocars and stapled transection of the pancreas. ETDP was performed via a gastrotomy, with 1 trocar for visualization, by using endoloop placement, snare transection, and purse-string gastrotomy closure.


METHODS
Clinical examination, CT, serum chemistries, necropsy, peritoneal fluid analysis, and histologic examination.


RESULTS
Swine were survived for 8 days. The procedure time for ETDP was significantly greater than for LDP (1:52 vs 0:33 [hours:minutes]; P = .00). Pancreatic specimen weight was similar (4.1 g vs 5.5 g; P = .108). Postoperatively, 26 of 28 animals thrived. In the LDP group, 1 death caused by pancreatic leak and renal failure occurred on day 1. In the ETDP group, 1 death caused by pneumothorax occurred intraoperatively. The necropsy, CT, and histologic examinations revealed focal resection-margin necrosis in 3 to 7 swine in the ETDP group with no proximal necrosis or pancreatitis. The groups were equivalent clinically, by survival, and by serum and peritoneal fluid analysis. The gastrotomy closure was associated with small serosal adhesions, but no gross abscess or necrosis.


CONCLUSIONS
Animal study.


CONCLUSIONS
In the largest controlled trial of NOTES orifice surgery to date, there was no clinical or survival difference between NOTES and laparoscopic approaches.
Willingham
Field F
FF
Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Gee
Denise W
DW
Sylla
Patricia
P
Kambadakone
Avinash
A
Singh
Anand H
AH
Sahani
Dushyant
D
Mino-Kenudson
Mari
M
Rattner
David W
DW
Brugge
William R
WR
D000818:Animals; D004724:Endoscopy; D010535:Laparoscopy; D023421:Models, Animal; D010180:Pancreatectomy / Q000379:methods*; D013552:Swine