Randomized study of natural orifice transluminal endoscopic surgery and endoscopy shows similar hemodynamic impact in a porcine model.
BACKGROUND
A previous porcine study showed a significant difference in heart rate and diastolic blood pressure (DBP) between natural orifice transluminal endoscopic surgery (NOTES) and laparoscopy. This study evaluated the hemodynamics during endoscopy, laparoscopy, and transluminal access.


METHODS
For this study, 37 female swine were randomized and invasively monitored in terms of blood and abdominal pressure, heart rate, and arterial blood gas (ABG) during 90-min procedures. Group 1 (n = 11) underwent NOTES peritoneoscopy; group 2 (n = 14) underwent 45-min diagnostic endoscopy, a 10-min washout period, and 35-min laparoscopy with mesh placement; and group 3 (n = 12) NOTES had transgastric mesh placement. The groups were compared using a mixed model and a Spearman trend test. This study was approved by Institutional Animal Care and Use Committee (IACUC).


RESULTS
No difference in the systolic blood pressure (SBP) was noted. During the initial 30 min, DBP increased significantly from baseline in groups 1 (p < 0.001) and 2 (p = 0.01), but not in group 3 (p = 0.08). The mean DBP did not differ between the groups. During laparoscopy, the average end-tidal carbon dioxide (CO(2)) level was 6.6 mmHg higher in group 2 than in group 1 (p = 0.01). The heart rate and ABG values did not differ between the groups (p ≥ 0.10).


CONCLUSIONS
Heart rate and DBP were similar for NOTES and endoscopy. The differences seen in a previous trial comparing NOTES and laparoscopy were not duplicated. The initial DBP increased for the endoscopy and diagnostic NOTES animals. Differences in end-tidal CO(2) were encountered again during the shortened laparoscopy segment.
Bingener
Juliane
J
Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA. bingenercasey.juliane@mayo.edu
Moran
Erica
E
Gostout
Chris J
CJ
Buck
Lauren
L
Schwesinger
Wayne
W
Van Sickle
Kent
K
Huebner
Marianne
M
D000818:Animals; D001794:Blood Pressure; D002245:Carbon Dioxide / Q000097:blood*; D005260:Female; D006339:Heart Rate; D006935:Hypercapnia / Q000209:etiology*; D007022:Hypotension / Q000209:etiology*; D007431:Intraoperative Complications / Q000209:etiology*; D010535:Laparoscopy / Q000009:adverse effects*; D016343:Monitoring, Intraoperative; D057605:Natural Orifice Endoscopic Surgery / Q000009:adverse effects*; D011028:Pneumoperitoneum, Artificial / Q000009:adverse effects; D011897:Random Allocation; D013270:Stomach; D013526:Surgical Mesh; D034421:Sus scrofa; D013552:Swine; D014630:Vagus Nerve / Q000503:physiopathology
D002245:Carbon Dioxide