Cardiopulmonary and immunologic effects of transvaginal natural-orifice transluminal endoscopic surgery cholecystectomy compared with laparoscopic cholecystectomy in a porcine survival model.
BACKGROUND
A few studies have addressed the physiology related to a basic natural-orifice transluminal endoscopy surgery (NOTES) procedure, such as transgastric peritoneoscopy, but the physiologic impact of more complex NOTES procedures has not been previously examined.


OBJECTIVE
To evaluate the cardiopulmonary and immunologic effects of transvaginal NOTES cholecystectomy compared with laparoscopic cholecystectomy.


METHODS
Survival experiments in 10 40-kg female pigs assigned to transvaginal cholecystectomy and laparoscopic cholecystectomy groups.


METHODS
Transvaginal cholecystectomy was performed with the assistance of a needlescopic device, and laparoscopic cholecystectomy was performed in the standard manner.


METHODS
Cardiopulmonary and immunologic parameters in the transvaginal cholecystectomy group were compared with those in the laparoscopic cholecystectomy group. Cardiopulmonary parameters included heart rate, blood pressure, saturation pulse oximetry, intratracheal pressure, and arterial blood gases. Immunologic parameters included white blood cell count, tumor necrosis factor-α, interleukin-1β, and interleukin-6.


RESULTS
All procedures were performed successfully without complications. Although operation times were longer for transvaginal cholecystectomy than for laparoscopic surgery, cardiopulmonary changes were similar and stable in both groups. White blood cell count, interleukin-1β, and interleukin-6 did not differ between the 2 groups, and the increase in tumor necrosis factor α after transvaginal cholecystectomy was significantly smaller on postoperative day 1 than after laparoscopic cholecystectomy (133.4 pg/mL vs 200.4 pg/mL; P < .05).


CONCLUSIONS
Animal model and small sample size.


CONCLUSIONS
Transvaginal cholecystectomy resulted in cardiopulmonary stability and well preserved immune function similar to those of laparoscopic cholecystectomy, suggesting that NOTES may be less invasive than laparoscopic surgery.
Department of Gastroenterological Surgery, Oita University Faculty of Medicine, Oita, Japan.
Kosuke
K
Suzuki
Kazuhiro
K
Yasuda
Koji
K
Kawaguchi
Fumitaka
F
Yoshizumi
Masafumi
M
Inomata
Norio
N
Shiraishi
Seigo
S
Kitano
D000818:Animals; D001784:Blood Gas Analysis; D002763:Cholecystectomy / Q000295:instrumentation*; D017081:Cholecystectomy, Laparoscopic / Q000295:instrumentation*; D005260:Female; D006439:Hemodynamics / Q000502:physiology*; D053583:Interleukin-1beta / Q000097:blood*; D015850:Interleukin-6 / Q000097:blood*; D007958:Leukocyte Count; D057605:Natural Orifice Endoscopic Surgery / Q000295:instrumentation*; D010538:Peritonitis / Q000473:pathology; D011183:Postoperative Complications / Q000473:pathology; D013552:Swine; D000267:Tissue Adhesions / Q000473:pathology; D014409:Tumor Necrosis Factor-alpha / Q000097:blood*
D053583:Interleukin-1beta; D015850:Interleukin-6; D014409:Tumor Necrosis Factor-alpha