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Randomized study of natural orifice transluminal endoscopic surgery and endoscopy shows similar hemodynamic impact in a porcine model

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Abstract

Background

A previous porcine study showed a significant difference in heart rate and diastolic blood pressure (DBP) between natural orifice transluminal endoscopic surgery (NOTES) and laparoscopy. This study evaluated the hemodynamics during endoscopy, laparoscopy, and transluminal access.

Methods

For this study, 37 female swine were randomized and invasively monitored in terms of blood and abdominal pressure, heart rate, and arterial blood gas (ABG) during 90-min procedures. Group 1 (n = 11) underwent NOTES peritoneoscopy; group 2 (n = 14) underwent 45-min diagnostic endoscopy, a 10-min washout period, and 35-min laparoscopy with mesh placement; and group 3 (n = 12) NOTES had transgastric mesh placement. The groups were compared using a mixed model and a Spearman trend test. This study was approved by Institutional Animal Care and Use Committee (IACUC).

Results

No difference in the systolic blood pressure (SBP) was noted. During the initial 30 min, DBP increased significantly from baseline in groups 1 (p < 0.001) and 2 (p = 0.01), but not in group 3 (p = 0.08). The mean DBP did not differ between the groups. During laparoscopy, the average end-tidal carbon dioxide (CO2) level was 6.6 mmHg higher in group 2 than in group 1 (p = 0.01). The heart rate and ABG values did not differ between the groups (p ≥ 0.10).

Conclusion

Heart rate and DBP were similar for NOTES and endoscopy. The differences seen in a previous trial comparing NOTES and laparoscopy were not duplicated. The initial DBP increased for the endoscopy and diagnostic NOTES animals. Differences in end-tidal CO2 were encountered again during the shortened laparoscopy segment.

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Acknowledgments

We thank Candace Baird, Registered Veterinary Technician, for her expert support of the experimental design and data collection. This study was supported by a research grant from the Natural Orifice Surgery Consortium for Assessment and Research (NOSCAR) and a material support grant (hemoclips) from Boston Scientific Inc.

Disclosures

Christopher J. Gostout is an advisor for Apollo Endosurgery, Inc. and has received grant support for animal research. He receives research grant support for the DEU from Olympus America. Juliane Bingener, Erica Moran, Lauren Buck, Wayne Schwesinger, Kent Van Sickle, and Marianne Huebner have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    Juliane Bingener, Erica Moran, Chris J. Gostout & Marianne Huebner

  2. Department of Gastroenterology, Mayo Clinic, Rochester, MN, USA

    Juliane Bingener & Chris J. Gostout

  3. Biostatistics and Epidemiology, Mayo Clinic, Rochester, MN, USA

    Marianne Huebner

  4. Department of Surgery, University of Texas Health Science Center San Antonio, San Antonio, TX, USA

    Lauren Buck, Wayne Schwesinger & Kent Van Sickle

Authors
  1. Juliane Bingener
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  2. Erica Moran
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  3. Chris J. Gostout
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  4. Lauren Buck
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  5. Wayne Schwesinger
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  6. Kent Van Sickle
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  7. Marianne Huebner
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Corresponding author

Correspondence to Juliane Bingener.

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Bingener, J., Moran, E., Gostout, C.J. et al. Randomized study of natural orifice transluminal endoscopic surgery and endoscopy shows similar hemodynamic impact in a porcine model. Surg Endosc 25, 1065–1069 (2011). https://doi.org/10.1007/s00464-010-1317-2

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  • DOI: https://doi.org/10.1007/s00464-010-1317-2

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