Rectal prolapse as a complication of transrectal NOTES in an experimental porcine model

Background: Rectal prolapse is the protrusion of one or more layers of the rectum through the anal sphincter. Some of the possible causes are tenesmus, endoparasitism and large bowel inflammation. Natural orifice transluminal endoscopic surgery (NOTES) consists of advanced techniques to gain access to body cavities through natural openings without skin incision. Different access routes may be used. However, transrectal NOTES has not been often reported. This paper reports a case of rectal prolapse after transrectal NOTES in a porcine model. Case: A healthy, female domestic swine underwent experimental peritoneoscopy through transrectal route. The animal weighed 20 kg and was approximately 90 days old. Under general anesthesia, a pneumoperitoneum was created and, after this, the rectal lining was pulled out and incised so that the endoscope could be introduced into the abdominal cavity. Subsequently, the cavity was deflated and the rectal wall was sutured under direct viewing with single-layer extramucosal sutures closed with 3-0 polyglactin 910 and simple continuous pattern in the muscular region and submucosa. There was edema of the rectal lining with a slight protrusion and was reduced manually. There was prolapse recurrence and a pursestring suture was placed around the anus. The suture ruptured about 72 h after the endoscopic procedure and self-mutilation of the perineal...(AU)

Rectal prolapse as a complication of transrectal NOTES in an experimental porcine model

Background: Rectal prolapse is the protrusion of one or more layers of the rectum through the anal sphincter. Some of the possible causes are tenesmus, endoparasitism and large bowel inflammation. Natural orifice transluminal endoscopic surgery (NOTES) consists of advanced techniques to gain access to body cavities through natural openings without skin incision. Different access routes may be used. However, transrectal NOTES has not been often reported. This paper reports a case of rectal prolapse after transrectal NOTES in a porcine model. Case: A healthy, female domestic swine underwent experimental peritoneoscopy through transrectal route. The animal weighed 20 kg and was approximately 90 days old. Under general anesthesia, a pneumoperitoneum was created and, after this, the rectal lining was pulled out and incised so that the endoscope could be introduced into the abdominal cavity. Subsequently, the cavity was deflated and the rectal wall was sutured under direct viewing with single-layer extramucosal sutures closed with 3-0 polyglactin 910 and simple continuous pattern in the muscular region and submucosa. There was edema of the rectal lining with a slight protrusion and was reduced manually. There was prolapse recurrence and a pursestring suture was placed around the anus. The suture ruptured about 72 h after the endoscopic procedure and self-mutilation of the perineal...

Biomarcadores inflamatórios e indicadores de estresse oxidativo em cadelas submetidas à ovariossalpingohisterectomia convencional, por NOTES híbrida e NOTES total / Inflammatory biomarkers and oxidative stress indicators in bitches subjected to conventional ovarysalpingohysterectomy, by hybrid NOTES and by total NOTE

Objetivou-se comparar a resposta inflamatória e o perfil oxidativo da técnica de ovariossalpingohisterectomia (OSH) convencional com duas técnicas de Cirurgia Endoscópica por Orifícios Naturais (NOTES). Foram utilizados 15 fêmeas, alocadas em três grupos de cinco animais. No primeiro grupo, a OSH foi realizada por celiotomia convencional, no segundo, por NOTES total e, no terceiro, por NOTES híbrida. Foram realizadas as coletas sanguíneas antes do procedimento cirúrgico (basal), 3, 6, 12, 24, 48 e 72h pós-operatórias. A atividade da catalase manteve-se alta nos três grupos estudados, entretanto a peroxidação lipídica, medida pelos níveis dos produtos de reação com o ácido tiobarbitúrico (TBARS), ocorreu mais acentuadamente no grupo convencional e foi quase que imperceptível no grupo de NOTES total. Nos três grupos estudados, ocorreu elevação na atividade da butirilcolinesterase e acetilcolinesterases, bem como aumento leucocitário neutrofílico nas primeiras horas pós-cirúrgicas. Conclui-se que a inflamação sistêmica acontece de forma similar nas três técnicas operatórias, com ressalva para as realizadas por NOTES total que mantiveram as mais baixas taxas oxidativas.(AU)

This study aimed at comparing the inflammatory response and the oxydative profile of the conventional ovarysalpingohysterectomy (OSH) technique to Totally Natural Orifice Transluminal Endoscopic Surgery (NOTES) and Hybrid NOTES. Group of fifteen female dogs was used for each technique. Blood samples were taken before the surgical procedure (basal) and 3, 6, 12, 24, 48 and 72h postoperative. The catalase activity was increased in the three studied groups. Nevertheless, lipid peroxidation, measured by TBARS (thiobarbituric acid reactive substances) levels, was higher in the conventional group and almost indistinguishable in the total NOTES group. In the three analyzed groups, both butyrylcholinesterase and acetylcholinesterase activities were increased as well as the neutrophil counts during the first post-surgical hours. It is possible to conclude that systemic inflammation occurs in a similar way in the three operative techniques; however, total NOTES technique presents lower levels of cellular oxidative damage, particularly if compared to the conventional approach.(AU)

Ovariectomia em cadelas por notes híbrida ou total: estudo de viabilidade técnica, análises álgica e de cortisol plasmático

O presente estudo busca comparar duas novas técnicas de ovariectomia (OVE) por NOTES transvaginal em cadelas quanto a viabilidade técnica, tempo cirúrgico e incidência de complicações trans e pós-operatórias, bem como quanto à concentração de cortisol plasmático e escores de dor no período pós-operatório. Para tanto, uma amostra de 16 cadelas foi separada em dois grupos, sendo os pacientes do GNH (n=8) submetidos à OVE por NOTES transvaginal híbrida e os do grupo GNT (n=8) submetidas à OVE por NOTES transvaginal total. Os tempos cirúrgicos não diferiram entre os grupos experimentais. Nenhum dos cães requereu resgate analgésico nos períodos trans ou pós-operatório. Quanto ao escore de dor, os grupos não diferiram significativamente entre si na maioria dos tempos estudados, com exceção da avaliação nas 72 horas após extubação, na escala visual analógica (EVA), onde o GNH demonstrou índices mais elevados de dor que o grupo GNT. Os valores do cortisol plasmático não diferiram entre os grupos na maioria dos tempos, exceto no basal, onde os do grupo GNT foram superiores. Os valores mais elevados de cortisol para ambos os grupos experimentais foram encontrados no pós-operatório imediato, porém considerados significativos apenas para o grupo GNH. Ambas as técnicas de NOTES propostas se mostraram viáveis e seguras na realização de OV em cadelas, desde que executadas em pacientes selecionados quanto às condições anatômicas. As duas técnicas apresentaram resultados semelhantes para os parâmetros avaliados, com baixas taxas de complicações e reduzido estímulo álgico nos períodos trans e pós-operatório.

The purpose of this study was to compare two transvaginal NOTES ovariectomy (OVE) techniques in bitches regarding technical issues, surgical time, complications, as well as plasma cortisol concentration and postoperative pain scores. A sample of 16 dogs was divided into two groups: GNH patients (n=8) underwent transvaginal hybrid-NOTES OVE; and GNT dogs (n=8) were submitted to transvaginal total-NOTES OVE. The surgical time was not different between groups. None of the dogs required rescue analgesic during or after surgery at any time point. Groups did not differ significantly from each other regarding pain scores, except for 72 hours after extubation on visual analogue scale (EVA) assessment. GNH group presented higher pain score than GNT at 72 hours. Plasma cortisol did not differ between groups in most time points. However, GNT group presented higher plasma cortisol at the baseline. Cortisol peaked at the immediate postoperative period in both groups, but was significantly raised only in the GNH group. Both NOTES OVE techniques were feasible and safe in dogs. However, proper patient selection is advised. Techniques showed similar results for all assessment. Both techniques presented low complications rates and reduced pain during and after surgery.

Atualidades em videocirurgia na medicina veterinária:cirurgia endoscópica transluminal por orifícios naturais(NOTES) e cirurgia laparoendoscópica por único portal (LESS) / News in veterinary videosurgery: natural orifices transluminal endoscopic surgery (NOTES)and laparoendoscopic single-site surgery (LESS)

O aprimoramento de cirurgias minimamente invasivas pode conferir resultados pós-operatórios aindamelhores, tais como melhorias na cicatrização e no aspecto estético, menor dor pós-operatória e diminuiçãodo período de internação hospitalar. A cirurgia endoscópica transluminal por orifícios naturais(Natural Orifice Transluminal Endoscopic Surgery - NOTES) em alguns casos pode ser alternativa àcirurgia laparoscópica, com a vantagem de eliminar incisões abdominais, uma vez que combina técnicaslaparoscópicas e endoscópicas para acessar o abdome através de orifícios naturais. Apesar de se tratarde acesso em desenvolvimento, muitas vantagens poderão ser atribuídas a NOTES, tais como menoresincidências de hérnias, de infecção da ferida operatória e de aderências. A cirurgia laparoendoscópicapor único portal (Laparoendoscopic Single-site Surgery- LESS) é outra modalidade atual dentro dosprocedimentos videocirúrgicos, na qual a operação é realizada por incisão cutânea única, com ou sem ouso de dispositivos ou equipamentos específicos. As indicações e contra-indicações de cada abordagemcirúrgica surgirão conforme o desenvolvimento técnico. Neste artigo, os autores abordam o histórico davideocirurgia na medicina veterinária e o estado atual das categorias de NOTES e LESS.(AU)

The improvement of minimally invasive surgery can provides better postoperative results, such as betterscar healing, improved cosmetics results, less postoperative pain and earlier discharge from hospital.Transluminal endoscopic surgery by natural orifices can be an alternative to laparoscopic surgery, withthe advantage of eliminating abdominal incisions since it combines endoscopic and laparoscopic techniquesto access the abdominal cavity via natural orifices. Despite being a technique under development,many advantages would be attributed to NOTES, such as lower incidence of hernias, surgical woundinfection and adhesion. The Laparoendoscopic Single Site Surgery (LESS) is another current techniquewithin the video surgical procedures of laparoscopic procedures, which is used a single abdominal incision,with our without specific devices and equipment. The indications and contra indications of eachapproach will arise according to the development of the surgical techniques. In this article, the authors review the history of the video surgery in veterinary medicine and the current conditions of NOTES andLESS categories.(AU)

Atualidades em videocirurgia na medicina veterinária:cirurgia endoscópica transluminal por orifícios naturais(NOTES) e cirurgia laparoendoscópica por único portal (LESS) / News in veterinary videosurgery: natural orifices transluminal endoscopic surgery (NOTES)and laparoendoscopic single-site surgery (LESS)

O aprimoramento de cirurgias minimamente invasivas pode conferir resultados pós-operatórios aindamelhores, tais como melhorias na cicatrização e no aspecto estético, menor dor pós-operatória e diminuiçãodo período de internação hospitalar. A cirurgia endoscópica transluminal por orifícios naturais(Natural Orifice Transluminal Endoscopic Surgery - NOTES) em alguns casos pode ser alternativa àcirurgia laparoscópica, com a vantagem de eliminar incisões abdominais, uma vez que combina técnicaslaparoscópicas e endoscópicas para acessar o abdome através de orifícios naturais. Apesar de se tratarde acesso em desenvolvimento, muitas vantagens poderão ser atribuídas a NOTES, tais como menoresincidências de hérnias, de infecção da ferida operatória e de aderências. A cirurgia laparoendoscópicapor único portal (Laparoendoscopic Single-site Surgery- LESS) é outra modalidade atual dentro dosprocedimentos videocirúrgicos, na qual a operação é realizada por incisão cutânea única, com ou sem ouso de dispositivos ou equipamentos específicos. As indicações e contra-indicações de cada abordagemcirúrgica surgirão conforme o desenvolvimento técnico. Neste artigo, os autores abordam o histórico davideocirurgia na medicina veterinária e o estado atual das categorias de NOTES e LESS.

The improvement of minimally invasive surgery can provides better postoperative results, such as betterscar healing, improved cosmetics results, less postoperative pain and earlier discharge from hospital.Transluminal endoscopic surgery by natural orifices can be an alternative to laparoscopic surgery, withthe advantage of eliminating abdominal incisions since it combines endoscopic and laparoscopic techniquesto access the abdominal cavity via natural orifices. Despite being a technique under development,many advantages would be attributed to NOTES, such as lower incidence of hernias, surgical woundinfection and adhesion. The Laparoendoscopic Single Site Surgery (LESS) is another current techniquewithin the video surgical procedures of laparoscopic procedures, which is used a single abdominal incision,with our without specific devices and equipment. The indications and contra indications of eachapproach will arise according to the development of the surgical techniques. In this article, the authors review the history of the video surgery in veterinary medicine and the current conditions of NOTES andLESS categories.