INTRODUCTION: A safe closure technique of transluminal access is essential for the widespread application of natural orifice transluminal endoscopic surgery (NOTES). AIM: To evaluate the feasibility and effectiveness of a novel single loop-and-clips closure technique (KING closure). MATERIAL AND METHODS: An experimental survival study using female laboratory pigs was performed. A gastrotomy was performed using a standard percutaneous endoscopic gastrostomy technique. A peritoneoscopy with an ovariectomy was then performed with a double-channel endoscope, on a total of 14 pigs. Two different techniques of gastrotomy closure were analysed: a loop-and-clips closure technique (n = 7) and a standard closure using endoclips (n = 7). After a follow-up period of 30 days, the animals were euthanized for post-mortem examination. RESULTS: In the "loop-and-clip" closure group, the correct placement of an endoloop and clips was achieved in all animals. At necropsy, no animal showed signs of an abscess or peritonitis. Histological examination demonstrated a patent full-thickness gastric wall closure without evidence of local complications in all instances. In the "clips" group, the gastrotomy closure was assessed as probably unsafe in three animals. At necropsy 3 (42.9%) abscesses and 1 (14.3%) case of peritonitis were found. CONCLUSIONS: A single loop-and-clips closure technique (KING closure) represents a feasible, simple and effective method of gastric incision closure. It appears to be superior to the standard endoscopic closure technique using clips.

• Publikační typ
• časopisecké články MeSH

• MeSH
• čas MeSH
• chirurgie trávicího traktu MeSH
• endoskopické operace přirozenými otvory * MeSH
• endoskopie * metody   přístrojové vybavení   MeSH
• endoskopy * MeSH
• laparoskopie MeSH
• lidé MeSH
• ovarektomie MeSH
• prasata MeSH
• vagina MeSH
• výsledek terapie MeSH
• výsledky a postupy - zhodnocení (zdravotní péče) MeSH
• zvířata MeSH
• Check Tag
• lidé MeSH
• zvířata MeSH

AIM: To compare natural orifice transluminal endoscopic surgery (NOTES) vs standard laparoscopic ovariectomy in mini pigs with respect to technical aspects, complications and parameters of systemic inflammatory response. METHODS: This was a randomized, experimental, survival study. Ten female mini pigs underwent NOTES transgastric ovariectomy (NOTES group) and ten female mini pigs underwent laparoscopic ovariectomy (LAP group). A "percutaneous endoscopic gastrostomy" approach with guidewire and sphincterotome was used for gastrotomy creation. The ovary was resected using standard biopsy forceps and a snare. The access site was closed using a "KING" closure with a single endoloop and several clips. In the laparoscopic group, a three-port laparoscopy and an ovariectomy were performed with the use of standard laparoscopic devices. C-reactive protein (CRP), white blood count and interleukin (IL)-6 plasma levels were used as indicators of systemic inflammatory response. All animals were euthanized 28 d after surgery. RESULTS: All animals survived without complications. The mean procedure time was 41.3 min ± 17.6 min (NOTES group) and 25.7 min ± 5.25 min (LAP group, P < 0.02). Postmortem examinations demonstrated that 50% and 70% of animals were free of any complications in the NOTES and LAP groups, respectively. The remaining animals developed minor complications (adhesions) in a comparable frequency between the two groups. In the NOTES group, one animal developed a small intramural gastric abscess close to the gastrotomy site. A minor serous exudate that was present in 50% and 40% of the animals in the NOTES and laparoscopy groups, respectively, was not considered a complication. In both groups CRP levels increased significantly on the 2nd and 7th postoperative days (POD) and returned to normal after 28 d. On POD 2, an increase of CRP level was significantly higher in the NOTES group compared to the LAP group. Values of IL-6 did not differ from baseline values in either of the groups postoperatively. Interestingly, the platelet count decreased significantly on POD 2, but returned close to baseline values on POD 7 and PODs 28-30. CONCLUSION: Both NOTES and laparoscopic ovariectomies had a similar frequency of minor complications. However, the NOTES technique produced an increased systemic inflammatory response on POD 2.

• MeSH
• biologické markery krev   MeSH
• C-reaktivní protein metabolismus   MeSH
• časové faktory MeSH
• chirurgické nástroje MeSH
• design vybavení MeSH
• endoskopické operace přirozenými otvory škodlivé účinky   přístrojové vybavení   MeSH
• interleukin-6 krev   MeSH
• laparoskopie škodlivé účinky   přístrojové vybavení   MeSH
• mediátory zánětu krev   MeSH
• miniaturní prasata MeSH
• ovarektomie škodlivé účinky   přístrojové vybavení   metody   MeSH
• počet leukocytů MeSH
• počet trombocytů MeSH
• prasata MeSH
• zánět krev   etiologie   imunologie   MeSH
• zvířata MeSH
• Check Tag
• ženské pohlaví MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• srovnávací studie MeSH

• Klíčová slova
• natural orifice translumenal endoscopic surgery (NOTES), minimálně invazivní chirurgie,
• MeSH
• C-reaktivní protein MeSH
• cholecystektomie laparoskopická MeSH
• cholecystektomie metody   MeSH
• financování organizované MeSH
• interleukin-6 MeSH
• laboratorní zvířata MeSH
• prasata MeSH
• prospektivní studie MeSH
• rektum MeSH
• statistika jako téma MeSH
• TNF-alfa MeSH
• žlučník chirurgie   MeSH
• zvířata MeSH
• Check Tag
• zvířata MeSH
• Publikační typ
• randomizované kontrolované studie MeSH