Comparative study of NOTES rectosigmoidectomy in a swine model: E-NOTES vs. P-NOTES

Area of Science:

• Minimally invasive surgery
• Surgical innovation
• Gastroenterology

Background:

• Natural orifice transluminal endoscopic surgery (NOTES) offers potential for reduced invasiveness.
• Previous studies suggest safety for pure NOTES (P-NOTES) and embryonic NOTES (E-NOTES).
• Comparative safety and applicability of different NOTES approaches for rectosigmoidectomy require further investigation.

Purpose of the Study:

• To compare the safety and applicability of E-NOTES versus P-NOTES rectosigmoidectomy.
• To evaluate operative outcomes and complication rates between the two NOTES techniques.
• To assess the feasibility of each approach in a swine model.

Main Methods:

• Rectosigmoidectomy was performed using E-NOTES (laparoscopic, single port) and P-NOTES (TEM with transgastric assistance) in swine.
• Gastrotomies were created and closed using specific techniques; T-anchors were used for closure.
• Systemic cytokine levels and operative outcomes were monitored; necropsy was performed one week post-procedure.

Main Results:

• P-NOTES rectosigmoidectomy had a significantly longer operative time (239 vs. 103 minutes) and shorter anastomosis distance (2.9 vs. 17.6 cm) compared to E-NOTES.
• P-NOTES showed a higher, though not statistically significant, complication rate (54.5% vs. 18.2%).
• No significant differences were observed in systemic cytokine level changes (TNF-α, CRP, IL-6, IL-1β).

Conclusions:

• E-NOTES rectosigmoidectomy is safe in a swine model but presents challenges in pelvic dissection.
• P-NOTES rectosigmoidectomy using TEM demonstrates potential for pelvic dissection.
• The transgastric approach in P-NOTES is associated with a high degree of risk.