Transrectal Hybrid NOTES versus Laparoscopic Cholecystectomy – A Randomized Prospective Study in a Large Laboratory Animal
Authors:
O. Ryska; T. Filipková 1; J. Martínek 2; R. Doležel 3; Š. Juhás 4; J. Juhásová 4; M. Zavoral 2; M. Ryska
Authors place of work:
Chirurgická klinika, Fakultní nemocnice na Bulovce Praha, přednosta: doc. MUDr. Jan Fanta, DrSc.
; Chirurgické oddělení Nemocnice Domažlice, a. s., primář: MUDr. Václav Šauer
1; Interní klinika 1. LFUK a ÚVN Praha, přednosta: prof. MUDr. Miroslav Zavoral, Ph. D.
2; Chirurgická klinika 2. LFUK a ÚVN Praha, přednosta: prof. MUDr. Miroslav Ryska, CSc.
3; Ústav živočišné fyziologie a genetiky AV ČR, Liběchov, prof. MVDr. Jan Motlík, DrSc.
4
Published in the journal:
Rozhl. Chir., 2011, roč. 90, č. 12, s. 695-700.
Category:
Monothematic special - Original
Práce byla podpořena grantem IGA – NR 9994 – 4.
Summary
Introduction:
NOTES (Natural Orifice Transluminal Endoscopic Surgery) technique was developed to achieve less invasive surgery with the aim to lower frequency of postoperative complications. Cholecystectomy is one of the most frequent elective surgical procedures and is relevant for evaluation of NOTES.
The aim of the experimental study was to compare hybrid transrectal and laparoscopic cholecystectomy regarding feasibility and inflammatory response.
Material and Methods:
A total of 20 pigs weighing 26–56 kg were randomized to laparoscopic or NOTES group. Transrectal approach (15–18 cm from anal edge) was created by needle knife, followed by balloon dilatation and two-channel endoscope was introduced into the abdominal cavity. Cystic artery and duct were clipped and dissected. After extirpation of the gall bladder the colostomy was closed by occlusion loop-and-clip (King’ closure) technique. In the laparoscopic group, cholecystectomy was performed by three-port access. Blood samples for evaluation of inflammatory response markers (leukocytes, CRP, interleukin 6) were taken 0, 2nd, 7th and 30th postoperative day, when the experiment ended and pig was euthanized.
Results:
Two pigs were excluded (1 died early postoperatively for pneumonia, 1 for the rectal closure impossibility after it’s laceration during of the gall bladder extirpation). Other pigs survived without complications. Procedure time was significantly longer in NOTES group (134 ± 27 minutes versus 60 ± 22 minutes, p < 0.05). White blood cells count and CRP level increased significantly in both groups 2nd and 7th postoperative day and then normalized. Differences between groups were not significant in any of the measured laboratory markers. Sectional finding of exudate and adhesions was comparable in both groups and all transrectal closures were healed. Small subhepatal abscess was found in one pig from NOTES group.
Conclusion:
Transrectal hybrid cholecystectomy is a safe and feasible method with comparable inflammatory responses and longer operating time compared to laparoscopy. A novel loop-and-clip technique was verified as a safe and simple rectal closure.
Key words:
natural orifice translumenal endoscopic surgery (NOTES) – minimal invasive surgery – cholecystectomy – laparoscopic cholecystectomy
Zdroje
1. Bergman, S., Melvin, W. S. Natural orifice translumenal endoscopic surgery. Surg. Clin. North Am., 2008; 88: 1131–1148.
2. Teoh, A. Y. B., Chiu, P. W. Y., Ng, E. K. W. Current developments in natural orifices transluminal endoscopic surgery: An evidence-based review. World J. Gastroenterol., 2010; 16(38): 4792–4799.
3. Dusek, T., Sítina, O., Spacek, V. Transgastric and transrectal hybrid NOTES cholecystectomy – experimental study. Rozhl. Chir., 2009; 88 (11): 670–673.
4. Sumiyama, K., Gostout, C. J., Rajan, E., et al. Transgastric cholecystectomy: transgastric accessibility to the gallbladder improved with the SEMF method and a novel multibending therapeutic endoscope. Gastrointest. Endosc., 2007; 65 (7): 1028–1034.
5. Rolanda, C., Lima, E., Pźgo, J. M., et al. Third-generation cholecystectomy by natural orifices: transgastric and transvesical combined approach (with video). Gastrointest. Endosc., 2007; 65 (1): 111–117.
6. Park, P. O., Bergström, M., Ikeda, K., Fritscher-Ravens, A., Swain, P. Experimental studies of transgastric gallbladder surgery: cholecystectomy and cholecystogastric anastomosis (videos). Gastrointest. Endosc., 2005; 61 (4): 601–606.
7. Pai, R. D., Fong, D. G., Bundga, M. E., Odze, R. D., Rattner, D. W., Thompson, C. C. Transcolonic endoscopic cholecystectomy: a NOTES survival study in a porcine model (with video). Gastrointest. Endosc., 2006; 64 (3): 428–434.
8. Suzuki, K., Yasuda, K., Kawaguchi, K., Yoshizumi, F., Inomata, M., Shiraishi, N., Kitano, S. Cardiopulmonary and immunologic effects of transvaginal natural-orifice transluminal endoscopic surgery cholecystectomy compared with laparoscopic cholecystectomy in a porcine survival model. Gastrointest. Endosc., 2010; 72 (6): 1241–1248.
9. Helstrom, L., Nilsson, B. Impact of vaginal surgery on sexuality and quality of life in women with urinary incontinence or genital descensus. Acta Obstet Gynecol. Scand., 2005; 84 (1): 79–84.
10. Voermans, R. P., Vergouwe, F., Breedveld, P., Fockens, P., van Berge Henegouwen, M. I. Comparison of endoscopic closure modalities for standardized colonic perforations in a porcine colon model. Endoscopy, 2011; 43 (3): 217–222.
11. Wilhelm, D., Meining, A., von Delius, S., Fiolka, A., Can, S., Hann von Weyhern, C., Schneider, A., Feussner, H. An innovative, safe and sterile sigmoid access (ISSA) for NOTES. Endoscopy, 2007; 39: 401–406.
12. Gupta, A., Watson, D. I. Effect of laparoscopy on immune function. Br. J. Surg., 2001; 88: 1296–306.
13. Ryska, O., Martinek, J., Dolezel, R., Filipkova, T., Juhas, S., Juhasova, J., Zavoral, M., Tuckova, I., Ryska, M. Feasibility of a novel single loop-and-clip gastrotomy closure (‘King’s closure’) after NOTES procedures in an experimental study. Gastroent. Hepatol., 2011; 65 (4): 126–132.
14. Zornig, C., Mofid, H., Siemssen, L., Emmermann, A., Alm, M., von Waldenfels, H. A., Felixmüller, C. Transvaginal NOTES hybrid cholecystectomy: feasibility results in 68 cases with mid-term follow-up. Endoscopy, 2009; 41: 391–394.
15. Tomikawa, M., Xu, H., Hashizume, M. Current status and prerequisites for natural kritice translumenal endoscopic surgery (NOTES). Surg. Today, 2010; 40 (10) :909–916.
16. Nau, P., Ellison, E. C., Muscarella, P., et al. A review of 130 humans enrolled in transgastric NOTES protocols at a single institution. Surg. Endosc., 2011; 25: 1004–1011.
17. Gordts, S., Waterlot, A., Campo, R., Grosens, I. Risk and outcome of bowel injury during transvaginal pelvic endoskopy. Fertil. Steril., 2001; 76: 1238–1241.
18. Salinas, G., Saavedra, L., Agurto, H., et al. Early expirience in human hybrid transgastric and transvaginal endoscopic cholecystectomy. Seurg. Endosc., 2010; 24: 1092–1098.
19. Park, P. O., Bergström, M. Transgastric peritoneoscopy and appendectomy: thoughts on our fisrt expirience in humans. Endoscopy, 2010; 42: 81–84.
20. Meining, A., Feussner, H., Swain, P., et al. Natural-orifice transluminal endoscopic surgery (NOTES) in Europe: summary of the working group reports of the Euro-NOTES meeting 2010. Endoscopy, 2010; 43 (2): 140–143.
21. Wilhelm, D., Meining, A., von Delius, S., Fiolka, A., Can, S., Hann von Weyhern, C., Schneider, A., Feussner, H. An innovative, safe and sterile sigmoid access (ISSA) for NOTES. Endoscopy, 2007; 39: 401–406.
22. Bingener, J., Krishnegowda, N. K., Michalek, J. E. Immunologic parameters during NOTES compared with laparoscopy in a randomized blinded porcine trial. Surg. Endosc., 2009; 23 (1): 178–181.
23. Hookey, L. C., Khokhotva, V., Bielawska, B., et al. The Queen‘s closure: a novel technique for closure of endoscopic gastrotomy for natural-orifice transluminal endoscopic surgery. Endoscopy, 2009; 41 (2): 149–153.
24. Hucl, T., Benes, M., Kocik, M., et al. A novel double-endoloop technique for natural orifice transluminal endoscopic surgery gastric access site closure. Gastrointest. Endosc., 2010; 71 (4): 806–811.
Štítky
Surgery Orthopaedics Trauma surgeryČlánok vyšiel v časopise
Perspectives in Surgery
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