title: Transgastric versus laparoendoscopic single-site peritoneoscopy in a rat model: effects on motility, inflammation, and nociception.
abstract: BACKGROUND
  Natural orifice translumenal endoscopic surgery (NOTES) and laparoendoscopic single-port surgery (LESS) are emerging approaches to abdominal surgery that have been advocated as potentially causing fewer physiologic derangements and less pain. This study aimed to compare these procedures in a novel rat model by assessing peritoneal inflammation, gastric motility, and nociception in response to peritoneoscopy performed via NOTES and LESS.
  
  
  METHODS
  Adult male rats underwent peritoneoscopy via either transgastric NOTES or LESS using the same type of endoscope and were allowed to recover for 2 to 4 h. Liquid gastric emptying was assessed using phenol red, and cytokine levels were analyzed in peritoneal washings. Thoracic spinal cord segments were stained for Finkel-Biskins-Jinkins osteosarcoma gene (FOS) to assess activation of nociceptive pathways.
  
  
  RESULTS
  The NOTES procedure significantly delayed both postsurgical recovery time compared with LESS (115 ± 25 vs. 82 ± 20 min, respectively; P = 0.04) and liquid gastric emptying (26.7 ± 11.1% vs. 57 ± 10.5%; P = 0.004). Several cytokines such as interleukin-1β (IL-1β), IL-6, monocyte chemoattractant protein-1 (MCP-1), and macrophage inflammatory protein-1 beta (MIP-1β) were significantly elevated in the NOTES group compared with the LESS group. However, the two groups did not differ significantly in spinal FOS activation.
  
  
  CONCLUSIONS
  The NOTES approach is feasible in an experimental rat model, facilitating a scientific approach to hypothesis testing through specific methods and instruments. The transgastric NOTES approach in rats is associated with a worse physiologic outcome in terms of gastric motility and peritoneal inflammation but does not differ significantly from LESS in activation of pain pathways.
authors: Division of Gastroenterology and Hepatology, Stanford University Medical Center, M211 Alway Building, 300 Pasteur Drive, MC: 5187, Stanford, CA 94305, USA.
authors: Jianqiang
authors: J
authors: Guo
authors: Neil P
authors: NP
authors: Pasricha
authors: Mohan M
authors: MM
authors: Shenoy
authors: Liansheng
authors: L
authors: Liu
authors: Kshama
authors: K
authors: Mehta
authors: Pankaj J
authors: PJ
authors: Pasricha
mesh_terms: D000818:Animals; D016207:Cytokines / Q000378:metabolism; D005746:Gastric Emptying / Q000502:physiology*; D016762:Genes, fos; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods*; D059225:Nociception / Q000502:physiology*; D010538:Peritonitis / Q000503:physiopathology*; D016760:Proto-Oncogene Proteins c-fos / Q000378:metabolism; D051381:Rats; D017207:Rats, Sprague-Dawley; D013116:Spinal Cord / Q000378:metabolism
chemical_list: D016207:Cytokines; D016760:Proto-Oncogene Proteins c-fos