title: Perioperative inflammatory response in natural orifice translumenal endoscopic surgery.
abstract: BACKGROUND
  Natural orifice translumenal endoscopic surgery (NOTES) could offer multiple advantages compared with the laparoscopic approach. One such potential advantage, not yet proven, is the inferior inflammatory response, which translates into less significant operative stress. This study aimed to compare the immuno-inflammatory response between transgastric NOTES and laparoscopy for simple surgical procedures (oophorectomy) with reference to the cytokine levels.
  
  
  METHODS
  For this study, 20 female pigs were randomly assigned to either NOTES or laparoscopic oophorectomy. Seven animals were used as a control group and received only general anesthesia, with no other procedure performed. Blood samples were obtained before surgery, 1 h after the start of the procedure, and at the end of the intervention. The serum levels of IL1β and IL6 were determined using a porcine enzyme-linked immunosorbent assay (ELISA) kit. The mean operative time, intraoperative incidents, and postoperative complications were recorded. On postoperative day 14, the animals were killed, and gastric leak tests were performed.
  
  
  RESULTS
  Both the NOTES and laparoscopic procedures were successfully completed. No gastric leaks were observed during necropsy. The transgastric oophorectomy required a significantly longer time to perform than the laparoscopic surgery. Compared with the NOTES procedures, laparoscopic oophorectomy resulted in significantly higher levels of interleukin-1β (IL1β) (42.34 ± 5.26 ng/ml with NOTES vs 46.93 ± 4.79 ng/ml with laparoscopy; p = 0.028) and IL6 (66.95 ± 7.29 ng/ml with NOTES vs 71.75 ± 4.76 ng/ml with laparoscopy, p = 0.049) during the postoperative phase. No statistical difference was detected between the pre- and postoperative cytokine levels in the NOTES group.
  
  
  CONCLUSIONS
  The study findings suggest that pure transgastric endoscopic surgery is a safe approach resulting in less perioperative inflammatory response than laparoscopy in the early postoperative phase.
authors: First Clinic of Surgery, Clinical County Emergency Hospital of Craiova, Tabaci 1, Craiova 200638, Romania.
authors: Ion
authors: I
authors: Georgescu
authors: Adrian
authors: A
authors: Saftoiu
authors: Stefan
authors: S
authors: Patrascu
authors: Isabela
authors: I
authors: Silosi
authors: Eugen
authors: E
authors: Georgescu
authors: Valeriu
authors: V
authors: Surlin
mesh_terms: D000818:Animals; D005260:Female; D007249:Inflammation / Q000209:etiology*; D053583:Interleukin-1beta / Q000097:blood*; D015850:Interleukin-6 / Q000097:blood*; D010535:Laparoscopy; D023421:Models, Animal; D057605:Natural Orifice Endoscopic Surgery; D061646:Operative Time; D010052:Ovariectomy / Q000379:methods; D011897:Random Allocation; D013552:Swine
chemical_list: D053583:Interleukin-1beta; D015850:Interleukin-6
references: Surg Endosc. 2009 Jun;23(6):1331-6
references: 18855060
references: Gastrointest Endosc. 2007 Dec;66(6):1243-5
references: 17892873
references: Surg Endosc. 2009 Feb;23(2):370-6
references: 18443862
references: JSLS. 2009 Jan-Mar;13(1):9-13
references: 19366533
references: Surg Endosc. 2004 Oct;18(10):1411-9
references: 15791361
references: Endoscopy. 2008 Jul;40(7):572-5
references: 18609450
references: Am J Gastroenterol. 1981 Nov;76(5):416-9
references: 6461246
references: Arch Surg. 2007 Sep;142(9):823-6; discussion 826-7
references: 17875836
references: Rom J Morphol Embryol. 2011;52(3):867-71
references: 21892532
references: Semin Laparosc Surg. 2004 Mar;11(1):37-44
references: 15094977
references: Surg Endosc. 2010 Jul;24(7):1727-36
references: 20108153
references: Surg Endosc. 2006 Feb;20(2):329-33
references: 16402290
references: Surg Endosc. 2009 Jul;23(7):1512-8
references: 19343435
references: Surg Endosc. 2008 Mar;22(3):605-11
references: 18027034
references: Surg Endosc. 2009 Jan;23(1):178-81
references: 18813979