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Transrectal rigid-hybrid NOTES cholecystectomy can be performed without peritoneal contamination: a controlled
Philip C Müller1, Jonas D Senft2, Philip Gath2
1Department of General, Visceral and Transplant Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany. philip.mueller@hotmail.com.
Background And Study Aims:
The risk of infectious complications due to peritoneal contamination is a major concern and inhibits the widespread use of transrectal NOTES. A standardized rectal washout with a reversible colon occlusion device in situ has previously shown potential in reducing peritoneal contamination. The aim of this study was to compare the peritoneal contamination rate and inflammatory reaction for transrectal cholecystectomy after ideal rectal preparation (trCCE) and standard laparoscopic cholecystectomy (lapCCE) in a porcine survival experiment.
Methods:
Twenty pigs were randomized to trCCE (n = 10) or lapCCE (n = 10). Before trCCE, rectal washout was performed with saline solution. A colon occlusion device was then inserted and a second washout with povidone-iodine was performed. The perioperative course and the inflammatory reaction (leukocytes, C-reactive protein) were compared. At necropsy, 14 days after surgery the abdominal cavity was screened for infectious complications and peritoneal swabs were obtained for comparison of peritoneal contamination.
Results:
Peritoneal contamination was lower after trCCE than after lapCCE (0/10 vs. 6/10; p = 0.003). No infectious complications were found at necropsy in either group and postoperative complications did not differ (p = 1.0). Immediately after the procedure, leukocytes were higher after lapCCE (17.0 ± 2.7 vs. 14.6 ± 2.3; p = 0.047). Leukocytes and C-reactive protein showed no difference in the further postoperative course. Intraoperative complications and total operation time (trCCE 114 ± 32 vs. 111 ± 27 min; p = 0.921) did not differ, but wound closure took longer for trCCE (31.5 ± 19 vs. 13 ± 5 min; p = 0.002).
Conclusions:
After standardized rectal washout with a colon occlusion device in situ, trCCE was associated without peritoneal contamination and without access-related infectious complications. Based on the findings of this study, a randomized controlled clinical study comparing clinical outcomes of trCCE with lapCCE should be conducted.
Insights
Transrectal cholecystectomy (trCCE) with rectal preparation significantly reduced peritoneal contamination compared to laparoscopic cholecystectomy (lapCCE). This novel approach shows promise for safer NOTES procedures by minimizing infectious complications.
Area of Science:
- Minimally Invasive Surgery
- Gastroenterology
- Surgical Innovation
Background:
- Peritoneal contamination risk limits transrectal Natural Orifice Transluminal Endoscopic Surgery (NOTES).
- Standardized rectal washout and colon occlusion show potential for reducing contamination.
Purpose of the Study:
- To compare peritoneal contamination and inflammatory response between transrectal cholecystectomy with ideal rectal preparation (trCCE) and standard laparoscopic cholecystectomy (lapCCE).
- To evaluate the safety and efficacy of a novel rectal preparation technique for transrectal NOTES procedures.
Main Methods:
- Twenty pigs underwent either trCCE (n=10) or lapCCE (n=10) in a survival experiment.
- trCCE involved standardized rectal washout and colon occlusion prior to the procedure.
- Peritoneal contamination, inflammatory markers (leukocytes, CRP), and perioperative outcomes were assessed.
Main Results:
- Peritoneal contamination was significantly lower in the trCCE group (0/10) compared to the lapCCE group (6/10; p=0.003).
- No infectious complications were observed in either group post-necropsy.
- While immediate postoperative leukocytes were higher in lapCCE, no significant differences in inflammatory markers or overall complications were noted during the follow-up period.
Conclusions:
- Standardized rectal washout with a colon occlusion device effectively prevents peritoneal contamination during transrectal cholecystectomy.
- trCCE is a safe and viable alternative to lapCCE with reduced infectious complication risk.
- A clinical trial is warranted to compare the outcomes of trCCE and lapCCE in human patients.
