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Inflammatory response and peritoneal contamination after transrectal natural orifice specimen extraction (NOSE) versus mini-laparotomy: a porcine in vivo study

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Abstract

Background

Transrectal natural orifice specimen extraction (NOSE) avoids abdominal organ retrieval during laparoscopic procedures and may reduce surgical trauma. However, this has not been proven clinically and transrectal peritoneal contamination is feared to cause infectious complications. This experimental study was designed to evaluate inflammatory response and peritoneal contamination after transrectal NOSE versus mini-laparotomy.

Methods

24 German Landrace pigs underwent transrectal NOSE (N = 12) or mini-laparotomy (N = 12) for standardized extraction of water-instilled balloon. Blood samples were taken for analysis of leucocytes, CRP, IL-6, IL-10, and TNFα at 6, 12, 24, 48, 72 h as well as 7 and 14 days postoperatively. After 14 days laparoscopy was performed to inspect the abdomen and for microbiological swab sampling.

Results

Leucocytes were higher in the NOSE group at 72 h (19.3 ± 3.9/nl vs. 15.8 ± 4.2/nl, p = 0.046). IL-6 was lower in the NOSE group at day 7 (165 ± 100/nl vs. 306 ± 70/nl, p = 0.030). No difference was found comparing inflammatory parameters at all other time points. No difference was found regarding peritoneal contamination, which was 58.3% (7/12) in the NOSE group and 41.7% (5/12) in the MiniLap group (p = 0.414).

Conclusions

The results suggest a pronounced acute inflammatory response after transrectal NOSE compared to mini-laparotomy, while late cytokine response seems to be less after transrectal NOSE, which may reflect less intense wound healing process. Using standardized rectal decontamination and endolumenal colon occlusion transrectal NOSE seems to be safe and comparable to mini-laparotomy with regard to peritoneal contamination. Clinical evidence is needed now to weight transrectal NOSE against mini-laparotomy during laparoscopic surgery.

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Abbreviations

NOSE:

Natural orifice specimen extraction

NOTES:

Natural orifice translumenal endoscopic surgery

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Acknowledgements

The authors wish to thank Béivin Pyne for revising this manuscript as a native English speaker.

Funding

This study was funded by institutional means of the University of Heidelberg.

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Authors and Affiliations

  1. Department of General, Visceral and Transplant Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany

    Jonas D. Senft, Tilman Dröscher, Philip Gath, Philip C. Müller, Adrian Billeter, Beat P. Müller-Stich & Georg R. Linke

  2. Department of Surgery, Spital STS AG, Krankenhausstrasse 12, 3600, Thun, Switzerland

    Georg R. Linke

Authors
  1. Jonas D. Senft
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  2. Tilman Dröscher
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  3. Philip Gath
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  4. Philip C. Müller
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  5. Adrian Billeter
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  6. Beat P. Müller-Stich
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  7. Georg R. Linke
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Corresponding author

Correspondence to Georg R. Linke.

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Disclosures

This study was funded solely by institutional means from the University Hospital of Heidelberg. The authors Jonas D. Senft, Tilman Dröscher, Philip Gath, Philip C. Müller, Adrian Billeter, Beat P. Müller-Stich and Georg R. Linke have no conflict of interest or financial ties to disclose.

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Senft, J.D., Dröscher, T., Gath, P. et al. Inflammatory response and peritoneal contamination after transrectal natural orifice specimen extraction (NOSE) versus mini-laparotomy: a porcine in vivo study. Surg Endosc 32, 1336–1343 (2018). https://doi.org/10.1007/s00464-017-5811-7

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  • DOI: https://doi.org/10.1007/s00464-017-5811-7

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