Comparative study of transgastric natural orifice transluminal endoscopic surgery vs. laparoscopy on stress response in experimental animals

Abstract

Objective To compare the effects of the transgastric natural orifice transluminal endoscopic surgery (NOTES) technique vs. the conventional laparoscopic technique on the stress response of the experimental swines, and evaluate the stress response of the transgastric NOTES technique. Methods Sixty local swines were randomly divided into transgastric NOTES group and laparoscopic group by random number table method. All animals were given exploratory laparotomy, and before anesthesia induction, at the end of surgery, at 24 h, 48 h, 72 h and 7 days after operation, white blood cell (WBC) counts, cortisol (CORT), C-reactive protein (CRP) and tumor necrosis factor (TNF)-α contents were measured. Results At the 6 time points, CRP and TNF-α showed no significant difference between two groups (CRP: t=0.982, P=0.435; t=0.675, P=0.570; t=1.354, P=0.082; t=1.728, P=0.256; t=0.815, P=0.428; t=1.294, P=0.374; TNF-α: t=2.514, P=0.548; t=4.007, P=0.746; t=1.582, P=0.279; t=1.624, P=0.315; t=1.356, P=0.395; t=0.997, P=0.104). The number of WBC (×109/L) at 24 and 72 h after operation was significantly greater in the NOTES group than that in the laparoscopic group (15.36±2.62 vs. 13.2±2.73, 18.84±6.41 vs. 16.80±5.02; t=14.578, P=0.012; t=12.175, P=0.047). CORT content (μg/dl) was significantly higher in the NOTES group than that in the laparoscopic group at the end of operation (29.72±10.30 vs. 21.74±8.70; t=18.126, P=0.017). At the rest time points, the number of WBC and CORT content between the two groups showed no significant difference (WBC: t=0.857, P=0.663; t=1.846, P=0.262; t=2.776, P=0.816; t=4.555, P=0.430; CORT: t=1.548, P=0.879; t=1.396, P=0.721; t=2.174, P=0.164; t=2.207, P=0.139; t=2.612, P=0.183). Conclusion As compared with laparoscopic surgery, based on the principle of aseptic surgery, the transgastric approach NOTES technology may not increase the stress response of experimental animals. Key words: Laparoscopy; Transgastric natural orifice transluminal endoscopic surgery technology; Stress reaction