Comparison of hemodynamic and inflammatory changes between transoral and transthoracic thoracoscopic surgery

Abstract

Background: Natural 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. Methods: Twenty-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. Results: The 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. Conclusions: This 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. Citation: Chu Y, Liu C-Y, Wu Y-C, Hsieh M-J, Chen T-P, et al. (2013) Comparison of Hemodynamic and Inflammatory Changes between Transoral and Transthoracic Thoracoscopic Surgery. PLoS ONE 8(1): e50338. doi:10.1371/journal.pone.0050338 Editor: Sai Yendamuri, Roswell Park Cancer Institute, United States of America Received May 22, 2012; Accepted October 17, 2012; Published January 3, 2013 Copyright: 2013 Chu et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Funding: This work was supported by Chang-Gung Memorial Hospital (CMRPG-391912 for YHL, and CMRPG-28028 and CMRPG-3A0371 for CYL, Taiwan) and by the National Science Council of Taiwan (NSC 100-2314-B-182A-052 for CYL). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Competing Interests: The authors have declared that no competing interests exist. * E-mail: foreverairmail@gmail.com (Y-HL); zebraairmail@gmail.com (H-PL) . These authors contributed equally to this work.