title: Comparison in efficacy between pure NOTES peritoneoscopy with small or large endoscope and laparoscopy.
abstract: OBJECTIVE
  To evaluate the efficacy and systematic impact of different sized endoscopes for pure transgastric natural orifice transluminal endoscopic surgery (NOTES) peritoneoscopy relative to laparoscopy.
  
  
  METHODS
  A total of 15 dogs were randomly assigned to the small-sized endoscope (SS), large-sized endoscope (LS) and standard laparoscopy (SL) groups. The procedure time, visualization scores for abdominal organs, gastric incision healing times and procedure-associated complications were recorded. Blood samples were collected at 1 h preoperation and at 1 h, 12 h, 2 days and 7 days postoperation. Serum tumor necrosis factor (TNF)-α and interleukin (IL)-6 levels as well as peripheral white blood cell (WBC) counts were analyzed.
  
  
  RESULTS
  Peritoneoscopy was successfully performed with both pure transgastric NOTES and laparoscopy. The peritoneoscopy required less time to complete in the SL group (44.0 ± 7.0 min) than the LS (83.0 ± 28.9 min) and SS (106.6 ± 81.3 min) groups (P < 0.01), but no statistical difference was observed between the SS and LS groups (P > 0.05). The visualization scores of peritoneal organs among the three groups did not differ significantly (P > 0.05). The gastric incision exhibited satisfactory healing in both the SS and LS groups. Moreover, serum TNF-α and IL-6 levels and WBC counts at each time point were similar among the three groups (P > 0.05).
  
  
  CONCLUSIONS
  Small-sized endoscope is not superior to a large-sized one for pure transgastric NOTES peritoneoscopy. Pure transgastric NOTES is not less invasive or less time-consuming than laparoscopy.
authors.affiliation: Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing, China.
authors.forename: Zi Kai
authors.initials: ZK
authors.lastname: Wang
authors.forename: Yun Sheng
authors.initials: YS
authors.lastname: Yang
authors.forename: Xiu Li
authors.initials: XL
authors.lastname: Zhang
authors.forename: Gang
authors.initials: G
authors.lastname: Sun
authors.forename: Qurratulain
authors.initials: Q
authors.lastname: Hyder
authors.forename: Li Li
authors.initials: LL
authors.lastname: Wu
authors.forename: Ping
authors.initials: P
authors.lastname: Tang
authors.forename: Wen
authors.initials: W
authors.lastname: Li
mesh_terms: D034861:Abdominal Wall / Q000601:surgery; D000818:Animals; D004285:Dogs; D005260:Female; D020706:Laparoscopes; D010535:Laparoscopy / Q000295:instrumentation*; D057605:Natural Orifice Endoscopic Surgery / Q000295:instrumentation* / Q000379:methods; D011184:Postoperative Period; D013270:Stomach / Q000601:surgery; D014409:Tumor Necrosis Factor-alpha / Q000097:blood
chemical_list: D014409:Tumor Necrosis Factor-alpha
keywords: endoscopy; inflammatory response; laparoscopy; natural orifice endoscopic surgery