title: Surgical Trauma Caused by Different Abdominal Access Routes-Comparison of Open Surgical, Laparoscopic, and NOTES Transgastric Techniques in a Porcine Model.
abstract: BACKGROUND
  Investigations indicate that natural orifice translumenal endoscopic surgery (NOTES) procedures induce a less pronounced postoperative inflammatory response than open or laparoscopic surgery, inflicting less trauma. In NOTES procedures, no skin incision is performed. We compare the inflammatory response added by the type of incision by measuring C-reactive protein (CRP) and tumors necrosis factor-alfa (TNF-α).
  
  
  METHODS
  Twenty-seven pigs were randomized to open surgical, laparoscopic, or transgastric NOTES abdominal access. After completion of the accesses, no surgery was performed. All accesses were left open for 40 minutes followed by closure, animals were survived for 7 days. Blood samples were drawn at the start of the accesses, at 20 and 40 minutes during the procedure, and at postoperative day (POD) 1, 3, and 7. Analyses of CRP and TNF-α were performed.
  
  
  RESULTS
  CRP increased in all animals until POD1. This increase was greater in the open group (P = .006). No significant differences in CRP-levels were found at POD 1, 3, or 7. TNF-α showed a peak during the procedure, at 20 and 40 minutes, with normalization at POD1 for 1/3 of the open and laparoscopic animals, but not for the NOTES animals. Due to variations within the groups, no statistical difference was shown between them. At postmortem, 1/3 of the pigs in the laparoscopic and open groups had wound infections, while no NOTES animals showed infections.
  
  
  CONCLUSIONS
  This study provides no statistically significant differences in inflammatory response after the different abdominal accesses. However, the lack of a TNF-α-peak in the NOTES group might indicate a less pronounced response, supporting the initial theories.
authors.affiliation: 1 Department of Surgery, South Älvsborg Hospital , Borås, Sweden .
authors.forename: Jorge
authors.initials: J
authors.lastname: Arroyo Vázquez
authors.affiliation: 1 Department of Surgery, South Älvsborg Hospital , Borås, Sweden .|2 Sahlgrenska Academy, Gothenburg University , Gothenburg, Sweden .
authors.forename: Maria
authors.initials: M
authors.lastname: Bergström
authors.affiliation: 3 Hospital Universitario Vall d'Hebron , Wider-Barcelona, Barcelona, Spain .
authors.forename: Joan
authors.initials: J
authors.lastname: Dot
authors.affiliation: 3 Hospital Universitario Vall d'Hebron , Wider-Barcelona, Barcelona, Spain .
authors.forename: Monder
authors.initials: M
authors.lastname: Abu-Suboh-Abadia
authors.affiliation: 3 Hospital Universitario Vall d'Hebron , Wider-Barcelona, Barcelona, Spain .|4 Vall d'Hebron Institut de Recerca, VHIR, Universitat Autònoma de Barcelona , Barcelona, Spain .
authors.forename: Carla
authors.initials: C
authors.lastname: Fonseca
authors.affiliation: 3 Hospital Universitario Vall d'Hebron , Wider-Barcelona, Barcelona, Spain .|4 Vall d'Hebron Institut de Recerca, VHIR, Universitat Autònoma de Barcelona , Barcelona, Spain .
authors.forename: Marielle
authors.initials: M
authors.lastname: Esteves
authors.affiliation: 2 Sahlgrenska Academy, Gothenburg University , Gothenburg, Sweden .
authors.forename: Asghar
authors.initials: A
authors.lastname: Azadani
authors.affiliation: 3 Hospital Universitario Vall d'Hebron , Wider-Barcelona, Barcelona, Spain .
authors.forename: Jordi
authors.initials: J
authors.lastname: Armengol
authors.affiliation: 3 Hospital Universitario Vall d'Hebron , Wider-Barcelona, Barcelona, Spain .
authors.forename: Miquel
authors.initials: M
authors.lastname: Masachs
authors.affiliation: 3 Hospital Universitario Vall d'Hebron , Wider-Barcelona, Barcelona, Spain .|4 Vall d'Hebron Institut de Recerca, VHIR, Universitat Autònoma de Barcelona , Barcelona, Spain .
authors.forename: José Ramon
authors.initials: JR
authors.lastname: Armengol-Miró
authors.affiliation: 1 Department of Surgery, South Älvsborg Hospital , Borås, Sweden .|2 Sahlgrenska Academy, Gothenburg University , Gothenburg, Sweden .
authors.forename: Per-Ola
authors.initials: PO
authors.lastname: Park
mesh_terms: D000818:Animals; D015415:Biomarkers / Q000097:blood; D004195:Disease Models, Animal; D005260:Female; D010535:Laparoscopy; D057605:Natural Orifice Endoscopic Surgery; D011183:Postoperative Complications; D011897:Random Allocation; D013272:Stomach Diseases / Q000097:blood / Q000601:surgery*; D013552:Swine; D014409:Tumor Necrosis Factor-alpha / Q000097:blood
chemical_list: D015415:Biomarkers; D014409:Tumor Necrosis Factor-alpha