Natural orifice transluminal endoscopic surgery vs laparoscopic ovariectomy： Complications and inflammatory response

AIM： To compare natural orifice transluminal endoscopic surgery （NOTES） vs standard laparoscopic ovari- ectomy in mini pigs with respect to technical aspects, complications and parameters of systemic inflammatory response. METHODS： This was a randomized, experimental,survival study. Ten female mini pigs underwent NOTES transgastric ovariectomy （NOTES group） and ten fe- male mini pigs underwent laparoscopic ovariectomy （LAP group）. A ＂percutaneous endoscopic gastrostomy＂ approach with guidewire and sphincterotome was used for gastrotomy creation. The ovary was resected us- ing standard biopsy forceps and a snare. The access site was closed using a ＂KING＂ closure with a single endoloop and several clips. In the laparoscopic group, a three-port laparoscopy and an ovariectomy were performed with the use of standard laparoscopic de- vices. C-reactive protein （CRP）, white blood count and interleukin （IL）-6 plasma levels were used as indicators of systemic inflammatory response. All animals were euthanized 28 d after surgery. RESULTS： All animals survived without complications. The mean procedure time was 41.3 min ＋ 17.6 min （NOTES group） and 25.7 min ＋ 5.25 min （LAP group, P 〈 0.02）. Postmortem examinations demonstrated that 50% and 70% of animals were free of any complica- tions in the NOTES and LAP groups, respectively. The remaining animals developed minor complications （ad- hesions） in a comparable frequency between the two groups. In the NOTES group, one animal developed a small intramural gastric abscess close to the gastrotomy site. A minor serous exudate that was present in 50% and 40% of the animals in the NOTES and laparoscopy groups, respectively, was not considered a complica- tion. In both groups CRP levels increased significantly on the 2nd and 7th postoperative days （POD） and re- turned to normal after 28 d. On POD 2, an increase of CRP level was significantly higher in the NOTES group compared to the LAP group. Values of IL-6 did not dif- fer from baseline values in either of the groups post- operatively. Interestingly, the platelet count decreased significantly on POD 2, but returned close to baseline values on POD 7 and PODs 28-30.CONCLUSION： Both NOTES and laparoscopic ovariec-tomies had a similar frequency of minor complications. However, the NOTES technique produced an increased systemic inflammatory response on POD 2.