title: Evaluation of systemic inflammatory responses in cholecystectomy by means of access. Single-port umbilical incision, transvaginal NOTES, laparoscopy and laparotomy.
abstract: OBJECTIVE
  To evaluate and compare clinical and inflammatory responses to the surgical trauma caused by cholecystectomy via several access approaches: single-port umbilical incision (SILS), transvaginal natural orifice transluminal endoscopic surgery (NOTES), laparoscopy, and Laparotomy.
  
  
  METHODS
  Twenty-eight female pigs were equally divided into four groups and submitted to cholecystectomy by single-port umbilical incision, transvaginal NOTES, laparoscopy, or Laparotomy. An additional five animals served as controls (sham group). Animals were monitored perioperatively regarding anesthesia and surgical procedure times, as well as for the presence of complications. Postoperatively, they were evaluated regarding time to ambulation and feeding, and the presence of clinical events. Procalcitonin, C-reactive protein (CRP), and AQUI feron-gamma (IFN-γ) measurements were performed before surgery and immediately, two days, and seven days after surgery. Animals were sacrificed and necropsied at seven days after surgery.
  
  
  RESULTS
  All procedures were successfully performed as proposed in each group. Only minor complications, such as gallbladder perforation and bleeding from the liver bed, were observed during surgery in all groups. The vaginal NOTES group showed higher anesthesia and surgical procedure times compared to the other groups (p<0.001). No other between-group differences in perioperative or postoperative times, clinical evolution, or serum inflammatory markers were observed. Only adhesions were found on necropsy, with no differences between groups.
  
  
  CONCLUSIONS
  The single-port umbilical and transvaginal NOTES access approaches were feasible and safe compared to laparoscopic and laparotomy for cholecystectomy.
authors.affiliation: Department of Surgery, Universidade Federal de São Paulo, Brazil.
authors.forename: Elesiário Marques
authors.initials: EM
authors.lastname: Caetano Júnior
authors.affiliation: Department of Surgery, Universidade Federal do Maranhão, Sao Luis, MA, Brazil.
authors.forename: Josiel Paiva
authors.initials: JP
authors.lastname: Vieira
authors.affiliation: Department of Surgery, UNIFESP, Sao Paulo, SP, Brazil.
authors.forename: Rita Maria A Monteiro
authors.initials: RM
authors.lastname: Moura-Franco
authors.affiliation: Department of Surgery, UNIFESP, Sao Paulo, SP, Brazil.
authors.forename: Rogerio Aoki
authors.initials: RA
authors.lastname: Fuziy
authors.affiliation: Department of Surgery, Universidade Federal do Maranhão, Sao Luis, MA, Brazil.
authors.forename: Humberto Oliveira
authors.initials: HO
authors.lastname: Serra
authors.affiliation: School of Medicine, UNIFESP, Sao Paulo, SP, Brazil.
authors.forename: Giulianna Barreira
authors.initials: GB
authors.lastname: Marcondes
authors.affiliation: School of Medicine, UNIFESP, Sao Paulo, SP, Brazil.
authors.forename: Daniel Kitayama
authors.initials: DK
authors.lastname: Shiraiwa
authors.affiliation: Department of Surgery, Universidade Federal da Paraiba, Joao Pessoa, PB, Brazil.
authors.forename: Marcelo Goncalves de
authors.initials: MG
authors.lastname: Sousa
authors.affiliation: Department of Surgery, UNIFESP, Sao Paulo, SP, Brazil.
authors.forename: Manoel João Batista Castello
authors.initials: MJ
authors.lastname: Girão
authors.affiliation: Department of Surgery, UNIFESP, São Paulo, SP, Brazil.
authors.forename: Gaspar de Jesus
authors.initials: Gde J
authors.lastname: Lopes-Filho
authors.affiliation: Department of Surgery, UNIFESP, Sao Paulo, SP, Brazil.
authors.forename: Marcelo Moura
authors.initials: MM
authors.lastname: Linhares
mesh_terms: D034861:Abdominal Wall / Q000473:pathology / Q000601:surgery; D000818:Animals; D002097:C-Reactive Protein / Q000032:analysis; D002116:Calcitonin / Q000097:blood; D002763:Cholecystectomy / Q000009:adverse effects* / Q000379:methods*; D005260:Female; D007371:Interferon-gamma / Q000097:blood; D007431:Intraoperative Complications; D057605:Natural Orifice Endoscopic Surgery / Q000009:adverse effects* / Q000379:methods*; D061646:Operative Time; D011183:Postoperative Complications; D011498:Protein Precursors / Q000097:blood; D015203:Reproducibility of Results; D013552:Swine; D018746:Systemic Inflammatory Response Syndrome / Q000209:etiology* / Q000473:pathology; D000267:Tissue Adhesions / Q000473:pathology; D014472:Umbilicus / Q000601:surgery; D014621:Vagina / Q000601:surgery
chemical_list: D011498:Protein Precursors; D007371:Interferon-gamma; D002116:Calcitonin; D002097:C-Reactive Protein