Microbiological contamination during transgastric and transvaginal endoscopic techniques

Area of Science:

• Minimally Invasive Surgery
• Gastroenterology
• Surgical Innovation

Background:

• Natural orifice transluminal endoscopic surgery (NOTES) is a developing alternative to traditional laparoscopic surgery.
• Concerns regarding peritoneal contamination remain a significant challenge for NOTES procedures.
• Assessing intraperitoneal bacterial load is crucial for evaluating NOTES safety.

Purpose of the Study:

• To evaluate the safety of transluminal surgery by comparing bacterial load and contamination.
• To investigate intraperitoneal contamination during transgastric and transvaginal NOTES procedures.
• To compare the safety profiles of transgastric versus transvaginal approaches in a porcine model.

Main Methods:

• Twelve female pigs underwent transgastric (tubal ligation, oophorectomy) and transvaginal (cholecystectomy) procedures.
• Peritoneal fluid samples were collected intraoperatively and post-mortem for microbiologic assessment.
• Procedures utilized a standard double-channel endoscope under general anesthesia.

Main Results:

• The transvaginal cholecystectomy group showed no signs of sepsis or bacterial growth.
• Three pigs in the transgastric group developed postoperative peritonitis, abscesses, and Escherichia coli contamination.
• Both transgastric and transvaginal approaches were technically feasible with current endoscopic equipment.

Conclusions:

• The transvaginal approach demonstrated a safer profile with reduced intra-abdominal contamination and sepsis compared to the transgastric route.
• While feasible, NOTES procedures necessitate the development of specialized instruments for safer peritoneal access.
• Further research into NOTES safety and instrument development is warranted for clinical adoption.