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Infection during natural orifice transluminal endoscopic surgery peritoneoscopy: a randomized comparative study in a survival porcine model.

Abstract：

BACKGROUND:Infection in natural orifice transluminal endoscopic surgery (NOTES) remains controversial. OBJECTIVE:To estimate the frequency of infection during NOTES peritoneoscopy with different routes of access and to compare with laparoscopy. DESIGN:Prospective randomized controlled study (Canadian Classification type I). METHODS:Forty female pigs were randomly assigned to 3 NOTES (transgastric, transrectal, and transvaginal) and laparoscopic groups. Antiseptic technique was used for NOTES, whereas laparoscopy was performed in a sterile environment. Preoperative and postoperative intravenous antibiotics were administered. Closure of the transluminal access site was performed in all animals. Peritoneal fluid was collected for culture at the end of surgery and at necropsy at day 14. RESULTS:Thirty-nine peritoneoscopies were successfully completed. Necropsy confirmed complete healing of NOTES incisions, but 2 animals in the laparoscopy group had small abscesses in the abdominal incisions. There were no statistical differences in the presence of peritoneal adhesions. Positive culture results were seen in all groups at the end of the procedure and in all animals at necropsy, but this did not lead to clinical signs of gross infection. The most common organisms that colonized the peritoneum were gram-positive cocci and gram-negative bacilli from the normal swine gastrointestinal flora. LIMITATIONS:Animal model and small sample size. CONCLUSIONS:In these small series of animals and with the careful lavage and preparation used, NOTES appeared to be comparable to laparoscopy in terms of peritoneal contamination and clinical infection. Despite the adherence to a strict antiseptic protocol, peritoneal contamination occurs but does not lead to septic complications in the swine.

journal_name

J Minim Invasive Gynecol

journal_title

Journal of minimally invasive gynecology

authors

Guarner-Argente C,Beltrán M,Martínez-Pallí G,Navarro-Ripoll R,Martínez-Zamora MÀ,Córdova H,Comas J,de Miguel CR,Rodríguez-D'Jesús A,Almela M,Hernández-Cera C,Lacy AM,Fernández-Esparrach G

doi

10.1016/j.jmig.2011.08.001

subject

Has Abstract

pub_date

2011-11-01 00:00:00

pages

741-6

issue

eissn

1553-4650

issn

1553-4669

pii

S1553-4650(11)00429-8

journal_volume

pub_type

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Infection during natural orifice transluminal endoscopic surgery peritoneoscopy: a randomized comparative study in a survival porcine model.