Abstract
BackgroundNatural orifice transluminal endoscopy has been developed for abdominal surgical procedures. The aim of this study was to compare the surgical outcome between a novel transoral approach and a standard transthoracic approach for the thoracic cavity in a canine model.MethodsTwenty-eight dogs were assigned to transoral (n = 14) or standard thoracoscopy (n = 14). Each group underwent thoracic exploration, pre-determined surgical lung biopsy, and pericardial window creation. Blood draws were obtained before surgery and at postoperative days 1, 3, 7, and 14. Operative time, complications, laboratory parameters, hemodynamic parameters, and inflammatory parameters were compared between the two procedures. The animals were monitored for two weeks and necropsy were performed for surgical outcome evaluation.ResultsThe thoracic procedures were successfully performed in all of the dogs, with the exception of one animal in the transoral group. There were no serious acute or delayed complications related to surgery. There was no difference between the two surgical groups for each of the hemodynamic parameters that were evaluated. Regarding the immunological impact of the surgeries, transoral thoracoscopy was associated with significant elevations in interleukin 6 and c-reactive protein levels on postoperative days 1 and 3, respectively, when compared with the standard thoracoscopy. All dogs recovered well, without signs of mediastinitis or thoracic infection. Necropsy revealed absence of infection, no injury to vital organs, and confirmed the success of the novel procedure.ConclusionsThis study suggests that both techniques were comparable with respect to procedure success rate, hemodynamic impact, and inflammatory changes. Furthermore, there was no difference in the incidence of postoperative discomfort between groups.
Highlights
Natural orifice transluminal endoscopic surgery (NOTES) has been used as a diagnostic and therapeutic platform to perform a wide variety of abdominal surgical procedures, including peritoneoscopy, cancer staging, appendectomy, cholecystectomy, and nephrectomy [1]–[4]
The feasibility of NOTES thoracoscopy has been demonstrated in various access methods in porcine and canine models [8]–[10]
We previously reported the use of a transoral technique to perform thoracoscopy, pericardial window creation, and surgical lung biopsy without complications in a survival canine model [11]–[13]
Summary
Natural orifice transluminal endoscopic surgery (NOTES) has been used as a diagnostic and therapeutic platform to perform a wide variety of abdominal surgical procedures, including peritoneoscopy, cancer staging, appendectomy, cholecystectomy, and nephrectomy [1]–[4]. To further evaluate the potential benefits of transoral thoracoscopy, we aimed to compare the surgical outcome of minor thoracic intervention using the recently developed transoral method compared with the standard transthoracic thoracoscopy in a randomized study. Inducible nitric oxide synthase (iNOS) expression of monocytes, and cytokine interleukin 6 (IL-6) are good guides in the assessment of the activation of the systemic inflammation to tissue injury The expression of these mediators as well as c-reactive protein (CRP) play a major role in the acute-phase response against surgical stress [14]–[15]. They are objective and quantitative parameters in the assessment of inflammatory system activation in response to operative trauma. The aim of this study was to compare the surgical outcome between a novel transoral approach and a standard transthoracic approach for the thoracic cavity in a canine model
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