Infection during natural orifice transluminal endoscopic surgery peritoneoscopy: a randomized comparative study in a survival porcine model.
BACKGROUND
Infection in natural orifice transluminal endoscopic surgery (NOTES) remains controversial.


OBJECTIVE
To estimate the frequency of infection during NOTES peritoneoscopy with different routes of access and to compare with laparoscopy.


METHODS
Prospective randomized controlled study (Canadian Classification type I).


METHODS
Forty female pigs were randomly assigned to 3 NOTES (transgastric, transrectal, and transvaginal) and laparoscopic groups. Antiseptic technique was used for NOTES, whereas laparoscopy was performed in a sterile environment. Preoperative and postoperative intravenous antibiotics were administered. Closure of the transluminal access site was performed in all animals. Peritoneal fluid was collected for culture at the end of surgery and at necropsy at day 14.


RESULTS
Thirty-nine peritoneoscopies were successfully completed. Necropsy confirmed complete healing of NOTES incisions, but 2 animals in the laparoscopy group had small abscesses in the abdominal incisions. There were no statistical differences in the presence of peritoneal adhesions. Positive culture results were seen in all groups at the end of the procedure and in all animals at necropsy, but this did not lead to clinical signs of gross infection. The most common organisms that colonized the peritoneum were gram-positive cocci and gram-negative bacilli from the normal swine gastrointestinal flora.


CONCLUSIONS
Animal model and small sample size.


CONCLUSIONS
In these small series of animals and with the careful lavage and preparation used, NOTES appeared to be comparable to laparoscopy in terms of peritoneal contamination and clinical infection. Despite the adherence to a strict antiseptic protocol, peritoneal contamination occurs but does not lead to septic complications in the swine.
Endoscopy Unit, Hospital Clínic, University of Barcelona, CIBERehd, Barcelona, Spain.
Carlos
C
Guarner-Argente
Mireia
M
Beltrán
Graciela
G
Martínez-Pallí
Ricard
R
Navarro-Ripoll
M Àngels
MÀ
Martínez-Zamora
Henry
H
Córdova
Jaume
J
Comas
Cristina Rodríguez
CR
de Miguel
Antonio
A
Rodríguez-D'Jesús
Manel
M
Almela
Clara
C
Hernández-Cera
Antonio M
AM
Lacy
Gloria
G
Fernández-Esparrach
D000818:Animals; D001424:Bacterial Infections / Q000209:etiology*; D005260:Female; D010535:Laparoscopy / Q000009:adverse effects*; D023421:Models, Animal; D057605:Natural Orifice Endoscopic Surgery / Q000009:adverse effects*; D010537:Peritoneum / Q000601:surgery*; D011897:Random Allocation; D013552:Swine