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Evaluation of bacterial contamination after “pure” (totally) transvaginal NOTES® diagnostic peritoneoscopy with biopsies in swine: a comparative study with laparoscopy

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Abstract

Introduction

Bacterial contamination from viscerotomy is a barrier to natural orifice translumenal endoscopic surgery (NOTES). The aim of this survival study is to evaluate pure (totally) transvaginal NOTES bacterial contamination compared with laparoscopy in pigs.

Methods

Twelve adult female pigs underwent peritoneoscopy with liver and peritoneal biopsies, using either laparoscopy (Glap, six animals) or pure transvaginal (GNOTES) access, and were maintained alive for 7 days. In all animals, blood cultures were taken at baseline, and after 24 h and 7 days postoperatively. Swab cultures from vagina (GNOTES) and skin (Glap) were obtained pre- and post-antisepsis. Peritoneal fluid culture was obtained at necropsy. For statistical analysis, Glap and GNOTES were compared for presence of positive bacterial cultures (qualitative bacterial analysis) using Fisher’s test, with level of significance set at p < 0.05.

Results

All animals had good postoperative outcome. One animal had transient perioperative bleeding from a transvaginal access. Two animals in Glap and one in GNOTES had positive blood cultures after the procedure. All animals from GNOTES and Glap presented with mixed flora pre-antisepsis. After antisepsis, one animal (GNOTES) presented with a positive vaginal swab culture (a single bacterial strain was identified). There was no positive skin swab culture in Glap. There were no signs of intra-abdominal infection at necropsy. In two animals, one from Glap and another from GNOTES, intra-abdominal culture was positive for Corynebacterium spp. and Escherichia coli, respectively. There was no correlation between the bacterial flora found at the access site and in the peritoneal cultures.

Conclusions

Pure transvaginal peritoneoscopy with liver and peritoneal biopsy in swine is feasible and associated with bacterial contamination comparable to laparoscopy. Peritoneal bacterial contamination was clinically insignificant after 1 week postoperatively. Preoperative antisepsis provided significant reduction of bacterial load prior to transvaginal and laparoscopic procedures.

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Acknowledgments

The authors would like to acknowledge Lyssandra Cravucov and Jordani Rodrigues for helping with collection of all samples used in the study. We would also like to acknowledge Sirlei Pereira and Vanderlei Muller for preparing and caring for the animals used in the study.

Disclosures

Drs. Eduardo Aimore Bonin, Christiano Marlo Paggi Claus, Antonio Carlos Ligocki Campos, and Marcelo de Paula Loureiro and Veterinarian Maria Fernanda Torres have no conflicts of interest or financial ties to disclose. Dr. Leandro Totti Cavazzola is an Advisory Board Member for Hernia for Bard and a Consultant for Hernia for Covidien; none of these relations has relevance for the present study.

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Authors and Affiliations

  1. Graduate Program in Minimally Invasive Surgery, Jacques Perissat Institute (IJP), Universidade Positivo, Curitiba, Brazil

    Eduardo Aimore Bonin, Christiano Marlo Paggi Claus & Marcelo de Paula Loureiro

  2. Universidade Federal do Parana, Curitiba, Brazil

    Maria Fernanda Torres & Antonio Carlos Ligocki Campos

  3. Surgical Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil

    Leandro Totti Cavazzola

  4. Rua Ottoni Maciel 755, Apt 304., Curitiba, PR, CEP 80030-200, Brazil

    Eduardo Aimore Bonin

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  1. Eduardo Aimore Bonin
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  2. Christiano Marlo Paggi Claus
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  3. Maria Fernanda Torres
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  4. Antonio Carlos Ligocki Campos
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  5. Leandro Totti Cavazzola
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  6. Marcelo de Paula Loureiro
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Correspondence to Eduardo Aimore Bonin.

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Aimore Bonin, E., Claus, C.M.P., Torres, M.F. et al. Evaluation of bacterial contamination after “pure” (totally) transvaginal NOTES® diagnostic peritoneoscopy with biopsies in swine: a comparative study with laparoscopy. Surg Endosc 27, 421–427 (2013). https://doi.org/10.1007/s00464-012-2448-4

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  • DOI: https://doi.org/10.1007/s00464-012-2448-4

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