title: Natural orifice transluminal endoscopic surgery vs laparoscopic ovariectomy: complications and inflammatory response.
abstract: OBJECTIVE
  To compare natural orifice transluminal endoscopic surgery (NOTES) vs standard laparoscopic ovariectomy in mini pigs with respect to technical aspects, complications and parameters of systemic inflammatory response.
  
  
  METHODS
  This was a randomized, experimental, survival study. Ten female mini pigs underwent NOTES transgastric ovariectomy (NOTES group) and ten female mini pigs underwent laparoscopic ovariectomy (LAP group). A "percutaneous endoscopic gastrostomy" approach with guidewire and sphincterotome was used for gastrotomy creation. The ovary was resected using standard biopsy forceps and a snare. The access site was closed using a "KING" closure with a single endoloop and several clips. In the laparoscopic group, a three-port laparoscopy and an ovariectomy were performed with the use of standard laparoscopic devices. C-reactive protein (CRP), white blood count and interleukin (IL)-6 plasma levels were used as indicators of systemic inflammatory response. All animals were euthanized 28 d after surgery.
  
  
  RESULTS
  All animals survived without complications. The mean procedure time was 41.3 min ± 17.6 min (NOTES group) and 25.7 min ± 5.25 min (LAP group, P < 0.02). Postmortem examinations demonstrated that 50% and 70% of animals were free of any complications in the NOTES and LAP groups, respectively. The remaining animals developed minor complications (adhesions) in a comparable frequency between the two groups. In the NOTES group, one animal developed a small intramural gastric abscess close to the gastrotomy site. A minor serous exudate that was present in 50% and 40% of the animals in the NOTES and laparoscopy groups, respectively, was not considered a complication. In both groups CRP levels increased significantly on the 2nd and 7th postoperative days (POD) and returned to normal after 28 d. On POD 2, an increase of CRP level was significantly higher in the NOTES group compared to the LAP group. Values of IL-6 did not differ from baseline values in either of the groups postoperatively. Interestingly, the platelet count decreased significantly on POD 2, but returned close to baseline values on POD 7 and PODs 28-30.
  
  
  CONCLUSIONS
  Both NOTES and laparoscopic ovariectomies had a similar frequency of minor complications. However, the NOTES technique produced an increased systemic inflammatory response on POD 2.
authors: Department of Internal Medicine, University Military Hospital, 16000 Prague, Charles University, Czech Republic. jan.martinek@volny.cz
authors: Jan
authors: J
authors: Martínek
authors: Ondřej
authors: O
authors: Ryska
authors: Tereza
authors: T
authors: Filípková
authors: Radek
authors: R
authors: Doležel
authors: Stefan
authors: S
authors: Juhas
authors: Jan
authors: J
authors: Motlík
authors: Monika
authors: M
authors: Holubová
authors: Vladimír
authors: V
authors: Nosek
authors: Barbora
authors: B
authors: Rotnáglová
authors: Miroslav
authors: M
authors: Zavoral
authors: Miroslav
authors: M
authors: Ryska
mesh_terms: D000818:Animals; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism; D004867:Equipment Design; D005260:Female; D007249:Inflammation / Q000097:blood / Q000209:etiology* / Q000276:immunology; D018836:Inflammation Mediators / Q000097:blood; D015850:Interleukin-6 / Q000097:blood; D010535:Laparoscopy / Q000009:adverse effects* / Q000295:instrumentation; D007958:Leukocyte Count; D057605:Natural Orifice Endoscopic Surgery / Q000009:adverse effects* / Q000295:instrumentation; D010052:Ovariectomy / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D010976:Platelet Count; D013525:Surgical Instruments; D013552:Swine; D013556:Swine, Miniature; D013997:Time Factors
chemical_list: D015415:Biomarkers; D018836:Inflammation Mediators; D015850:Interleukin-6; D002097:C-Reactive Protein