title: Carbon dioxide versus room air for natural orifice transluminal endoscopic surgery (NOTES) and comparison with standard laparoscopic pneumoperitoneum.
abstract: BACKGROUND
  Most studies investigating natural orifice transluminal endoscopic surgery (NOTES) have used room air, whereas carbon dioxide (CO(2)) is traditionally preferred for laparoscopic insufflation.
  
  
  OBJECTIVE
  Evaluation of CO(2) versus room air for NOTES and comparison with standard laparoscopic pneumoperitoneum.
  
  
  METHODS
  Prospective experiments in an acute porcine model.
  
  
  METHODS
  For transgastric peritoneoscopy, either CO(2) or room air were insufflated via the endoscope for a constant intraperitoneal pressure of 12 mm Hg in 16 pigs. Another 8 pigs received laparoscopic insufflation with CO(2). Identification of intra-abdominal organs during NOTES was documented. Additionally, standardized video recordings of peritoneoscopy were evaluated by an independent blinded observer. Complete cardiopulmonary status was assessed every 3 minutes.
  
  
  METHODS
  Quality of transgastric peritoneoscopy and cardiopulmonary response.
  
  
  RESULTS
  In the NOTES room air group, significantly more target organs (18/64, 28%) were missed than in the NOTES CO(2) group (8/64, 13%; P = .028). However, blinded video analysis showed no difference between the groups. An increase in systemic vascular resistance index during pneumoperitoneum in the NOTES room air group was less pronounced than in the NOTES CO(2) group, almost reaching the level of significance (P = .050). With respect to hemodynamics, there were no significant differences between the NOTES CO(2) group and the laparoscopy CO(2) group.
  
  
  CONCLUSIONS
  Nonsurvival animal experiments.
  
  
  CONCLUSIONS
  Pressure-controlled endoscopic insufflation of CO(2) for NOTES showed minor advantages compared with insufflation of room air regarding intra-abdominal visualization, but resulted in an increase in cardiac afterload. However, the cardiorespiratory responses during endoscopic insufflation of CO(2) were similar to the widely accepted standard laparoscopic CO(2) insufflation.
authors.affiliation: 2nd Medical Department, Technische Universität München, Klinikum rechts der Isar, Munich, Germany. stefan_ruckert@yahoo.de
authors.forename: Stefan
authors.initials: S
authors.lastname: von Delius
authors.forename: Johanna
authors.initials: J
authors.lastname: Sager
authors.forename: Hubertus
authors.initials: H
authors.lastname: Feussner
authors.forename: Dirk
authors.initials: D
authors.lastname: Wilhelm
authors.forename: Phillip
authors.initials: P
authors.lastname: Thies
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Huber
authors.forename: Tibor
authors.initials: T
authors.lastname: Schuster
authors.forename: Armin
authors.initials: A
authors.lastname: Schneider
authors.forename: Roland M
authors.initials: RM
authors.lastname: Schmid
authors.forename: Alexander
authors.initials: A
authors.lastname: Meining
mesh_terms: D000388:Air; D000818:Animals; D002245:Carbon Dioxide; D005260:Female; D005773:Gastroscopy / Q000379:methods*; D006439:Hemodynamics / Q000502:physiology; D007431:Intraoperative Complications / Q000503:physiopathology; D010535:Laparoscopy / Q000379:methods*; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D011028:Pneumoperitoneum, Artificial / Q000379:methods*; D012680:Sensitivity and Specificity; D013552:Swine; D014655:Vascular Resistance / Q000502:physiology; D014741:Video Recording
chemical_list: D002245:Carbon Dioxide