title: Stress response and well-being after open, laparoscopic, and NOTES transgastric uterine horn resection in a randomized porcine model.
abstract: BACKGROUND
  NOTES is believed to induce less surgical trauma than open and laparoscopic surgery. The degree of surgical trauma can be assessed by measuring serum levels of acute-phase proteins such as CRP and TNF-α. We conducted a prospective randomized survival trial in which the inflammatory responses after laparoscopic, open, and NOTES transgastric uterine horn resection were compared. The aim of this study was to investigate whether NOTES procedures induce less inflammatory response.
  
  
  METHODS
  Thirty pigs were randomized into three groups to undergo open, laparoscopic, or transgastric uterine horn resection. Weight, body temperature, and postoperative recovery were recorded and venous blood samples were taken for analysis of CRP and TNF-α at different time points. Analyses of CRP and TNF-α were performed using pig-specific ELISA assays.
  
  
  RESULTS
  Procedure time was significantly longer for NOTES [median = 121 min (range = 94-155)] compared with that for open surgery [median = 22 min (14-27)] and laparoscopy [median = 37 min (20-45)] (p < 0.0001). There was a nonsignificant tendency for shorter recovery time for the NOTES animals. Twenty-seven animals survived for 4 weeks. One animal in each group was euthanized prior to 4 weeks. All animals gained weight during the 4-week period with no significant differences. Only animals in the NOTES group showed a significant weight gain during the first postoperative week (p = 0.007). On postoperative day (POD) 1, CRP was significantly lower in the NOTES group compared with the open and laparoscopic groups (mean = 0.72 ± 0.22, 0.98 ± 0.26, and 0.97 ± 0.20, respectively; p = 0.048). The CRP levels were normalized on day 14. Throughout the study there were no significant changes in TNF-α levels in the laparoscopic and NOTES groups. At POD 3 the open surgery group showed significantly higher TNF-α levels than the other groups (p = 0.036).
  
  
  CONCLUSIONS
  Despite the longer operating time, the transgastric NOTES approach seems to be less traumatic than open or laparoscopic uterine horn resection in this porcine model.
authors.affiliation: Department of Surgery, South Alvsborg Hospital, Brämhultsv 53, 50182, Borås, Sweden, emc.begstrom@telia.com.
authors.forename: Maria
authors.initials: M
authors.lastname: Bergström
authors.forename: Asghar
authors.initials: A
authors.lastname: Azadani
authors.forename: Peter
authors.initials: P
authors.lastname: Falk
authors.forename: Per-Ola
authors.initials: PO
authors.lastname: Park
mesh_terms: D000762:Anesthesia Recovery Period; D000818:Animals; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis*; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D010535:Laparoscopy; D057605:Natural Orifice Endoscopic Surgery; D061646:Operative Time; D011446:Prospective Studies; D011897:Random Allocation; D013552:Swine; D014409:Tumor Necrosis Factor-alpha / Q000097:blood*; D014599:Uterus / Q000601:surgery*; D015430:Weight Gain
chemical_list: D015415:Biomarkers; D014409:Tumor Necrosis Factor-alpha; D002097:C-Reactive Protein