Immunologic parameters during NOTES compared with laparoscopy in a randomized blinded porcine trial.

Area of Science:

• Minimally Invasive Surgery
• Surgical Immunology
• Gastroenterology

Background:

• The comparative invasiveness of Natural Orifice Translumenal Endoscopic Surgery (NOTES) versus laparoscopy remains unclear.
• Immunologic markers like serum interleukins and peritoneal cellular response are used to differentiate surgical techniques.
• This study investigated the immunologic response to NOTES compared to laparoscopic peritoneoscopy.

Purpose of the Study:

• To compare cytokine levels and white blood cell (WBC) counts between NOTES and laparoscopic peritoneoscopy.
• To determine if NOTES is less invasive than laparoscopy based on immunologic markers.

Main Methods:

• Twelve pigs underwent either NOTES or standard laparoscopy with diagnostic peritoneoscopy for 90 minutes.
• Pneumoperitoneum was achieved using air for NOTES and CO(2) for laparoscopy.
• Serum cytokine levels (IL-1b and TNF-alpha) and WBC counts were measured at baseline, procedure end, and on postoperative days 1, 2, and 7.

Main Results:

• No significant difference in serum and intraperitoneal white blood cell counts between the groups.
• Interleukin-1b levels did not differ between NOTES and laparoscopy at any time point.
• Tumor necrosis factor-alpha (TNF-alpha) levels increased in the NOTES group on postoperative days 1-7, while decreasing in the laparoscopy group.

Conclusions:

• Early (24-hour) cytokine and WBC responses were similar between laparoscopic and NOTES procedures.
• The findings do not support the hypothesis that NOTES is less invasive than laparoscopy.
• The late elevation of TNF-alpha in the NOTES group warrants further investigation.