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Updated: Jun 24, 2026
Postoperative Ileus Murine Model
Published on: July 12, 2024
Minimal contamination of the human peritoneum after transvesical incision
Shawn M McGee1, Jonathan C Routh, Claudio W Pereira
1Department of Urology, Mayo Medical School and Mayo Clinic, Rochester, Minnesota 55905, USA.
Background And Purpose:
The recent literature has questioned the infectious risk of natural orifice translumenal endoscopic surgery (NOTES). The need for a clean portal of entry may be important to minimize peritoneal contamination after NOTES. Our study examines the resultant microbial contamination of the human peritoneum after transvesical incision and exposure of the abdomen to bladder contents during robot-assisted laparoscopic prostatectomy (RALP) to better understand the potential for infection in transvesical NOTES.
Patients And Methods:
Sixty consecutive men undergoing RALP for clinically localized prostate adenocarcinoma from January to May 2008 were prospectively studied as part of a database approved by an Institutional Review Board. The patient's preoperative urine microscopy values, complete blood cell count, and prostate-specific antigen (PSA) levels were recorded, along with the total length of time the cystotomy was open to the peritoneum. Intraoperative samplings of peritoneal fluid were collected before and after transvesical incision and sent for anaerobic, aerobic and fungal cultures.
Results:
Patients undergoing RALP had peritoneal exposure after transvesical incision for an average of 118 minutes. Five of 60 (8.3%) patients had evidence of novel aerobic bacterial contamination of the peritoneum after RALP. No patient had a positive anaerobic culture or fungal culture from the peritoneum. Preoperative serum leukocyte and PSA levels were elevated in patients with peritoneal contamination (P < 0.05). Remaining clinicopathologic features, total operative time, or open cystotomy time did not predict peritoneal contamination.
Conclusion:
Prolonged peritoneal exposure to bladder contents demonstrates minimal contamination of the abdominal cavity and is without postoperative infectious significance. This study may overestimate bacterial contamination via the bladder during RALP, because the specific bacteria seen may have originated from the seminal or prostatic fluid during prostatectomy. Transvesical incision would effectively be a clean portal of entry for NOTES with its low rate of peritoneal contamination.
Insights
Transvesical incision during robot-assisted laparoscopic prostatectomy shows minimal peritoneal contamination, suggesting it is a safe entry for natural orifice translumenal endoscopic surgery (NOTES) with low infection risk.
Area of Science:
- Minimally Invasive Surgery
- Surgical Infection Control
- Urology
Background:
- Natural orifice translumenal endoscopic surgery (NOTES) safety is debated regarding infectious risks.
- A clean portal of entry is crucial for minimizing peritoneal contamination during NOTES procedures.
Purpose of the Study:
- To assess peritoneal microbial contamination following transvesical incision during robot-assisted laparoscopic prostatectomy (RALP).
- To evaluate the safety of transvesical entry for potential NOTES applications.
Main Methods:
- Prospective study of 60 men undergoing RALP.
- Collection of peritoneal fluid samples before and after transvesical incision for microbial cultures (aerobic, anaerobic, fungal).
- Recording of preoperative patient data including urine microscopy, CBC, and PSA levels.
Main Results:
- 8.3% of patients (5/60) showed aerobic bacterial contamination post-incision.
- No anaerobic or fungal contamination was detected.
- Elevated preoperative leukocyte and PSA levels correlated with contamination, but operative time did not.
Conclusions:
- Transvesical incision during RALP results in minimal peritoneal contamination, posing no significant postoperative infectious risk.
- This approach represents a potentially clean portal of entry for transvesical NOTES.
- Bacterial findings may be influenced by prostatic/seminal fluid, not solely bladder contents.
