Evaluation of the clinical and inflammatory responses in exclusively NOTES transvaginal cholecystectomy versus laparoscopic routes: an experimental study in swine

Vieira, Josiel Paiva; Linhares, Marcelo Moura; Caetano, E. M.; Moura, Ricardo P.; Asseituno, Vitor; Fuzyi, Rogério; Girão, Manoel Joâo Batista Castello; Ruano, José M.; Goldenberg, Alberto; Filho, Gaspar de Jesus Lopes; Matos, Délcio

doi:10.1007/s00464-012-2329-x

Cited by 11 publications

(10 citation statements)

References 98 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In our study, however, measurable levels of IL-1 β and IL-6 were present only in 7.3% and 43.3% of samples, respectively. Nevertheless, this finding is consistent with those of others who reported undetectable IL-1 β or IL-6 serum levels in most or even all samples [ 11 , 30 , 31 ]. Either the sensitivity of our assay was not low enough to detect small amounts of cytokines or we did not evaluate our samples at an optimal time.…”

Section: Discussionsupporting

confidence: 93%

See 1 more Smart Citation

Comparison of Inflammatory Response to Transgastric and Transcolonic NOTES

Hucl

Benes

Kočík

et al. 2016

Gastroenterology Research and Practice

View full text Add to dashboard Cite

Aims. The aim of our study was to determine the physiologic impact of NOTES and to compare the transgastric and transcolonic approaches. Methods. Thirty pigs were randomized to transgastric, transcolonic, or laparoscopic peritoneoscopy. Blood was drawn and analyzed for C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), interleukin- (IL-) 1β, IL-6, WBCs, and platelets. Results. Endoscopic closure with an OTSC was successful in all 20 animals. The postoperative course was uneventful in all animals. CRP values rose on day 1 in all animals and slowly declined to baseline levels on day 14 with no differences between the groups (P > 0.05, NS). The levels of TNF-α were significantly increased in the transcolonic group (P < 0.01); however this difference was already present prior to the procedure and remained unchanged. No differences were observed in IL1-β and IL-6 values. There was a temporary rise of WBC on day 1 and of platelets on day 7 in all groups (P > 0.05, NS). Conclusions. Transgastric, transcolonic, and laparoscopic peritoneoscopy resulted in similar changes in systemic inflammatory markers. Our findings do not support the assumption that NOTES is less invasive than laparoscopy.

show abstract

Section: Discussionsupporting

confidence: 93%

“…In our study, we observed constant TNF- α levels in all groups. Similarly, others have seen no differences between NOTES and laparoscopy in TNF- α [ 28 – 31 ]. For unknown reasons, the serum TNF- α concentrations in the transcolonic group were significantly higher than in the 2 other groups.…”

Section: Discussionmentioning

confidence: 95%

Comparison of Inflammatory Response to Transgastric and Transcolonic NOTES

Hucl

Benes

Kočík

et al. 2016

Gastroenterology Research and Practice

View full text Add to dashboard Cite

show abstract

“…These issues contributed to increase the operative time in the hybrid NOTES cases compared to the laparoscopic cases. This finding is consistent with previous research [2, 8, 10, 18, 19, 20, 21, 22]. For instance, our analysis indicates that the emergence of new substeps to setup the transvaginal access increased the surgical time suggesting the requirement of a specific training for general surgeons to improve their performance in this step.…”

Section: Discussionsupporting

confidence: 92%

“…Currently, this technique is not easy to perform [7]. It is more demanding for the surgeons compared to conventional techniques, as it is more difficult to control the pressure during insufflation, and more difficult to use the unfamiliar new tools [8, 9]. …”

Section: Introductionmentioning

confidence: 99%

“…A similar foundation called EURO-NOTES has also been established in Europe to support the research efforts for NOTES [17]. However, to date, only a few published studies have compared the conventional laparoscopic surgery to NOTES cholecystectomy, all with a focus on the clinical outcomes of each technique [2, 8, 10, 18, 19, 20, 21, 22]. A review of these studies shows that there is currently neither an agreement regarding the feasibility and safety of NOTES in direct comparison to conventional laparoscopic surgery, nor a common metric to compare the two techniques.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Toward scar-free surgery: an analysis of the increasing complexity from laparoscopic surgery to NOTES

et al. 2014

View full text Add to dashboard Cite

Background NOTES is an emerging technique for performing surgical procedures, such as cholecystectomy. Debate about its real benefit over the traditional laparoscopic technique is on-going. There have been several clinical studies comparing NOTES to conventional laparoscopic surgery. However, no work has been done to compare these techniques from a Human Factors perspective. This study presents a systematic analysis describing and comparing different existing NOTES methods to laparoscopic cholecystectomy. Methods Videos of endoscopic/laparoscopic views from fifteen live cholecystectomies were analyzed to conduct a detailed task analysis of the NOTES technique. A hierarchical task analysis of laparoscopic cholecystectomy and several hybrid transvaginal NOTES cholecystectomies was performed and validated by expert surgeons. To identify similarities and differences between these techniques, their hierarchical decomposition trees were compared. Finally, a timeline analysis was conducted to compare the steps and substeps. Results At least three variations of the NOTES technique were used for cholecystectomy. Differences between the observed techniques at the substep level of hierarchy and on the instruments being used were found. The timeline analysis showed an increase in time to perform some surgical steps and substeps in NOTES compared to laparoscopic cholecystectomy. Conclusion As pure NOTES is extremely difficult given the current state of development in instrumentation design, most surgeons utilize different hybrid methods – combination of endoscopic and laparoscopic instruments/optics. Results of our hierarchical task analysis yielded an identification of three different hybrid methods to perform cholecystectomy with significant variability amongst them. The varying degrees to which laparoscopic instruments are utilized to assist in NOTES methods appear to introduce different technical issues and additional tasks leading to an increase in the surgical time. The NOTES continuum of invasiveness is proposed here as a classification scheme for these methods, which was used to construct a clear roadmap for training and technology development.

show abstract