title: Comparison of hemodynamic and inflammatory changes between transoral and transthoracic thoracoscopic surgery.
abstract: BACKGROUND
  Natural orifice transluminal endoscopy has been developed for abdominal surgical procedures. The aim of this study was to compare the surgical outcome between a novel transoral approach and a standard transthoracic approach for the thoracic cavity in a canine model.
  
  
  METHODS
  Twenty-eight dogs were assigned to transoral (n = 14) or standard thoracoscopy (n = 14). Each group underwent thoracic exploration, pre-determined surgical lung biopsy, and pericardial window creation. Blood draws were obtained before surgery and at postoperative days 1, 3, 7, and 14. Operative time, complications, laboratory parameters, hemodynamic parameters, and inflammatory parameters were compared between the two procedures. The animals were monitored for two weeks and necropsy were performed for surgical outcome evaluation.
  
  
  RESULTS
  The thoracic procedures were successfully performed in all of the dogs, with the exception of one animal in the transoral group. There were no serious acute or delayed complications related to surgery. There was no difference between the two surgical groups for each of the hemodynamic parameters that were evaluated. Regarding the immunological impact of the surgeries, transoral thoracoscopy was associated with significant elevations in interleukin 6 and c-reactive protein levels on postoperative days 1 and 3, respectively, when compared with the standard thoracoscopy. All dogs recovered well, without signs of mediastinitis or thoracic infection. Necropsy revealed absence of infection, no injury to vital organs, and confirmed the success of the novel procedure.
  
  
  CONCLUSIONS
  This study suggests that both techniques were comparable with respect to procedure success rate, hemodynamic impact, and inflammatory changes. Furthermore, there was no difference in the incidence of postoperative discomfort between groups.
authors.affiliation: Department of Thoracic Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Yen
authors.initials: Y
authors.lastname: Chu
authors.forename: Chien-Ying
authors.initials: CY
authors.lastname: Liu
authors.forename: Yi-Cheng
authors.initials: YC
authors.lastname: Wu
authors.forename: Ming-Ju
authors.initials: MJ
authors.lastname: Hsieh
authors.forename: Tzu-Ping
authors.initials: TP
authors.lastname: Chen
authors.forename: Ying-Kai
authors.initials: YK
authors.lastname: Chao
authors.forename: Ching-Yang
authors.initials: CY
authors.lastname: Wu
authors.forename: Hsu-Chia
authors.initials: HC
authors.lastname: Yuan
authors.forename: Po-Jen
authors.initials: PJ
authors.lastname: Ko
authors.forename: Yun-Hen
authors.initials: YH
authors.lastname: Liu
authors.forename: Hui-Ping
authors.initials: HP
authors.lastname: Liu
mesh_terms: D000818:Animals; D002097:C-Reactive Protein / Q000378:metabolism; D004285:Dogs; D004797:Enzyme-Linked Immunosorbent Assay; D006439:Hemodynamics; D007249:Inflammation / Q000473:pathology*; D015850:Interleukin-6 / Q000378:metabolism; D007962:Leukocytes / Q000166:cytology; D007963:Leukocytes, Mononuclear / Q000166:cytology; D008168:Lung / Q000601:surgery; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods*; D009504:Neutrophils / Q000166:cytology; D052247:Nitric Oxide Synthase Type II / Q000378:metabolism; D018384:Oxidative Stress; D010491:Pericardial Window Techniques; D011184:Postoperative Period; D013906:Thoracoscopy / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D015850:Interleukin-6; D002097:C-Reactive Protein; D052247:Nitric Oxide Synthase Type II