The influence on immunologic parameters during NOTES in a porcine survival model.

OBJECTIVE: To analyze the effect of natural orifice transluminal endoscopic surgery (NOTES) on the survival of animals, by comparing the change of intraoperative and postoperative immunologic parameters of NOTES with laparoscopy. MATERIALS AND METHODS: Twenty pigs were randomized to treatment with NOTES or standard laparoscopy. Each group underwent diagnostic peritoneoscopy by laparoscopy or NOTES in 90 minutes. Laboratory values, including interleukin-1 (IL-1) and tumor necrosis factor-α (TNF-α), were obtained at baseline, at intraoperative minute (IOM) 30, 60, and 90, and on postoperative day (POD) 1, 3, and 7. RESULTS: All procedures were successfully completed and all animals (except one in the NOTES group) survived to POD 14. The level of IL-1 and TNF-α was not significantly different compared with the preoperative level of IL-1 and TNF-α in both groups at IOM 30 and 60. It increased significantly at IOM 90 and POD 1 and 3 in both groups. Although levels of both IL-1 and TNF-α were higher in the NOTES group compared with the other group, there was no significant difference between the groups. At POD 7, the level of IL-1 and TNF-α decreased to near-normal levels in both groups. CONCLUSIONS: Although preliminary, the findings in this study do not currently support the assumption that NOTES is less invasive than laparoscopy. Further research is required to confirm these findings.

Minimally invasive phasic treatment protocol for the treatment of extrahepatic bile duct stones.

OBJECTIVES: To identify the optimal treatment for extrahepatic bile duct stones using endoscopy, laparoscopy, and the combination of the two in different conditions and to develop phasic treatment protocols for their minimally invasive treatment. PATIENTS AND METHODS: Of 2718 cases of extrahepatic bile duct stones collected from June 2005 to December 2011, 50 were randomly selected to receive open bile duct exploration and T-tube drainage, serving as the control group. For the rest, a one-scope protocol, two-scope protocol (two-scope protocol A or two-scope protocol B), or three-scope protocol was adopted according to the specific conditions of stones and the endoscopic treatment results. The treatment outcomes and postoperative clinical indicators of the minimally invasive treatment protocols were analyzed and compared with those of the control group. RESULTS: Among the 2668 cases of extrahepatic bile duct stones receiving the phasic minimally invasive treatment, the treatment success rate was 97.79%, and there were no severe postoperative complications. Compared with the control group, the minimally invasive treatment protocols had higher success rates, less trauma, and significantly shortened hospital stays. CONCLUSIONS: The protocols were applied step by step based on the different types and levels of extrahepatic bile duct stones, fully embodying the advantages of the combined minimally invasive treatment of endoscopy and laparoscopy, thus expanding the scope of minimally invasive surgical treatment for extrahepatic bile duct stones and improving treatment success rate.

The safety and utility of pancreatic duct stents in the emergency ERCP of acute biliary pancreatitis but difficult sphincterotomy.

BACKGROUND/AIMS: The aims of this study were to assess the feasibility and safety of emergency ERCP and pancreatic duct (PD) stenting in acute biliary pancreatitis (ABP) patients in whom biliary endoscopic sphincterotomy proved difficult, and to compare the clinical outcome of those patients having emergency ERCP without pancreatic stent. METHODOLOGY: One hundred and ninety-one consecutive patients with ABP were included in this study. Patients were randomly assigned to either the stent group (n=78) or the no-stent group (n=113). In the stent group, 3-5Fr,5-7cm-long pancreatic stent insertion was initially applied and removed endoscopically 1-2 weeks post-ER-CP. All patients were hospitalized for medical therapy and were followed-up. RESULTS: Mean age, initial symptom-to-ERCP times, Glasgow severity scores and peak amylase and CRP levels at initial presentation were not significantly different in the stent group vs. the no-stent group, and the selective biliary cannulation was achieved in 80% of the stent group and in 94% of the no-stent group (p=0.15). More importantly, the complication rate was significantly lower in the stent group (7.7% vs. 31.9%). There was no difference in mortality between the two groups statistically(1.3% vs. 3.5%). CONCLUSIONS: Pancreatic duct stent-ing is a safe and effective procedure that may afford sufficient PD decompression to reverse the process of ABP, show better outcomes as compared to no-stent group. It is recommended to reduce the incidence of the complication in the emergency ERCP of ABP but difficult sphincterotomy. However, further prospective trials are needed.

Systemic stress responses after laparoendoscopic single-site hepatectomy: a perspective controlled study.

BACKGROUND/AIMS: This study aimed to evaluate the technical feasibility of laparoendoscopic single-site hepatectomy (LESH) and compared stress responses with laparoscopic hepatectomy (LH) through a perspective controlled trial. METHODOLOGY: Thirty small female family pigs as animal models were divided into LESH and LH groups randomly. The data about operations including operating time, blood loss and complication rates were recorded. The stress indicators, including adrenaline, serum cortisol, interleukin-1, interleukin-6 and white blood cell count, were measured at baseline and 1, 24 and 48 hours postoperatively. RESULTS: In LESH group, 1 case was converted to LH for uncontrolled blooding. The other 29 cases underwent respective operations successfully. Postoperative recovery was without complications. Mean operative time of LESH group and LH group was 94.7±31.3 vs. 76.9±24.3min (p=0.0929). The blood loss of two groups was 72.5±26.4 vs. 66.3±21.2mL and there was no statistical difference. In both groups stress indicators showed a rising trend after operations and had no significant differences at the same time point. CONCLUSIONS: LESH is a safe, feasible and minimally invasive approach and has no different impact on stress responses compared to LH. It may be a reasonable alternative to apply in clinical practice by experienced laparoscopic physicians.