Endolumenal colon occlusion reduces peritoneal contamination during a transrectal NOTES procedure: a controlled porcine survival study.
To enable an efficient and enduring decontamination of the rectal mucosa during transanal endosocopic procedures, we developed a device for reversible endolumenal colon occlusion (ColoShield). The aim of this study was to assess the value of ColoShield in reducing peritoneal contamination during a transrectal procedure.



Sixteen pigs underwent transrectal hybrid NOTES cholecystectomy after standardized disinfective rectal washout either with endolumenal colon occlusion using ColoShield (N = 8) or without colon occlusion (N = 8). Rectal swab samples were taken before and after rectal washout and at the end of the procedure. Peritoneal biopsies for microbiological evaluation were obtained at the end of the procedure and at necropsy 7 days after surgery.



Peritoneal contamination at the end of surgery was significantly lower using ColoShield compared to not using colon occlusion [13 (1/8) vs. 75 % (6/8); P = 0.012]. No significant differences were found regarding contamination of rectal swabs and peritoneal contamination at necropsy.



The application of ColoShield may increase the safety of transrectal NOTES and transanal endoscopic procedures by reducing peritoneal contamination and consecutive infectious complications.
Department of General, Visceral and Transplant Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
Jonas D
JD
Senft
Department of General, Visceral and Transplant Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
Benedict
B
Carstensen
Department of Infectious Diseases, Medical Microbiology and Hygiene, University of Heidelberg, Im Neuenheimer Feld 324, 69120, Heidelberg, Germany.
Alexander
A
Mischnik
Institute of Medical Biometry and Informatics, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
Rene
R
Warschkow
Department of General, Visceral and Transplant Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
Beat P
BP
Müller-Stich
Department of General, Visceral and Transplant Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany. georg.linke@med.uni-heidelberg.de.
Georg R
GR
Linke
D000818:Animals; D001706:Biopsy; D002763:Cholecystectomy / Q000295:instrumentation* / Q000379:methods; D004867:Equipment Design; D023421:Models, Animal; D057605:Natural Orifice Endoscopic Surgery / Q000295:instrumentation* / Q000379:methods; D010537:Peritoneum / Q000382:microbiology*; D013530:Surgical Wound Infection / Q000517:prevention & control*; D013552:Swine
Clinical outcomes; Colon occlusion; Contamination; Endoscopy; Infection; Natural orifice translumenal endoscopic surgery (NOTES); Transanal endoscopic microsurgery (TEM); Transrectal