Randomized blinded trial comparing the cardiopulmonary effects of NOTES with standard laparoscopy in a porcine survival model

Juliane Bingener, Joel Michalek, John Winston, Kent Van Sickle, Vicky Haines, Wayne Schwesinger, Valerie Lawrence

Research output: Contribution to journalArticle

29 Citations (Scopus)

Abstract

Background: Anecdotal reports of natural orifice translumenal endoscopic surgery (NOTES) procedures in patients are emerging. Whether the new procedure is truly less invasive is not known. We compared perioperative cardiopulmonary parameters during NOTES with standard laparoscopy. Methods: Twelve swine were randomized to transgastric peritoneoscopy with air or diagnostic laparoscopy with CO2. Cardiopulmonary parameters were invasively monitored. Animals were survived for 14 days. Data were analyzed by an investigator blinded to the procedure performed. Treatments were contrasted on the mean outcome using a repeated measures linear model. Results: All experiments were successfully completed. No gastric leak or peritonitis resulted. Two hundred and fifty cubic centimeters of saline irrigation was adequate to decrease gastric contamination. Respiratory compromise requiring desufflation resulted in two laparoscopy and one endoscopy animal. Mean arterial oxygen saturation remained at baseline for the NOTES group and decreased by 1.5 ± 1.5% in the laparoscopic group (p < 0.001). Mean arterial pH dropped significantly lower in the laparoscopy versus the NOTES group (-0.09 ± 0.06 versus -0.05 ± 0.05, p = 0.01). Mean systolic blood pressure (Sbp) in both groups remained unchanged from the respective baseline (p = 0.45). Mean diastolic blood pressure (Dbp) showed a mean difference of 19 ± 1.5 mmHg between the groups (p < 0.001), increasing from baseline for the laparoscopy group and decreasing significantly from baseline in the NOTES group (+2.4 ± 12.5 versus -6.1 ± 7.0 mmHg, p < 0.001). Mean heart rate increased significantly from baseline in the laparoscopy group compared to the NOTES group (15.0 ± 23.4 versus 3.8 ± 19.0 bpm, p = 0.004). A widening pulse pressure resulted in the NOTES group compared to the laparoscopy group (p < 0.001). The mean bladder pressure was 14.6 ± 8.0 cmH2O in the laparoscopy group compared to 7.1 ± 7.1 cm H2O the NOTES group (p < 0.001). Conclusion: Significant differences in measured but not clinically apparent cardiopulmonary parameters were encountered. The difference in insufflation gas, different vagal or catecholamine response may be contributing to these findings.

Original languageEnglish (US)
Pages (from-to)1430-1434
Number of pages5
JournalSurgical Endoscopy and Other Interventional Techniques
Volume22
Issue number6
DOIs
StatePublished - Jun 2008

Fingerprint

Natural Orifice Endoscopic Surgery
Laparoscopy
Swine
Blood Pressure
Stomach
Insufflation
Peritonitis
Endoscopy
Catecholamines
Linear Models
Urinary Bladder
Heart Rate
Gases
Air
Research Personnel
Oxygen

Keywords

  • Cardiopulmonary parameters
  • Infection
  • Laparoscopy
  • Natural orifice surgery
  • NOTES
  • Randomized trial

ASJC Scopus subject areas

  • Surgery

Cite this

Randomized blinded trial comparing the cardiopulmonary effects of NOTES with standard laparoscopy in a porcine survival model. / Bingener, Juliane; Michalek, Joel; Winston, John; Van Sickle, Kent; Haines, Vicky; Schwesinger, Wayne; Lawrence, Valerie.

In: Surgical Endoscopy and Other Interventional Techniques, Vol. 22, No. 6, 06.2008, p. 1430-1434.

Research output: Contribution to journalArticle

Bingener, Juliane ; Michalek, Joel ; Winston, John ; Van Sickle, Kent ; Haines, Vicky ; Schwesinger, Wayne ; Lawrence, Valerie. / Randomized blinded trial comparing the cardiopulmonary effects of NOTES with standard laparoscopy in a porcine survival model. In: Surgical Endoscopy and Other Interventional Techniques. 2008 ; Vol. 22, No. 6. pp. 1430-1434.
@article{dad783f098fc41149634639b69f5e4d0,
title = "Randomized blinded trial comparing the cardiopulmonary effects of NOTES with standard laparoscopy in a porcine survival model",
abstract = "Background: Anecdotal reports of natural orifice translumenal endoscopic surgery (NOTES) procedures in patients are emerging. Whether the new procedure is truly less invasive is not known. We compared perioperative cardiopulmonary parameters during NOTES with standard laparoscopy. Methods: Twelve swine were randomized to transgastric peritoneoscopy with air or diagnostic laparoscopy with CO2. Cardiopulmonary parameters were invasively monitored. Animals were survived for 14 days. Data were analyzed by an investigator blinded to the procedure performed. Treatments were contrasted on the mean outcome using a repeated measures linear model. Results: All experiments were successfully completed. No gastric leak or peritonitis resulted. Two hundred and fifty cubic centimeters of saline irrigation was adequate to decrease gastric contamination. Respiratory compromise requiring desufflation resulted in two laparoscopy and one endoscopy animal. Mean arterial oxygen saturation remained at baseline for the NOTES group and decreased by 1.5 ± 1.5{\%} in the laparoscopic group (p < 0.001). Mean arterial pH dropped significantly lower in the laparoscopy versus the NOTES group (-0.09 ± 0.06 versus -0.05 ± 0.05, p = 0.01). Mean systolic blood pressure (Sbp) in both groups remained unchanged from the respective baseline (p = 0.45). Mean diastolic blood pressure (Dbp) showed a mean difference of 19 ± 1.5 mmHg between the groups (p < 0.001), increasing from baseline for the laparoscopy group and decreasing significantly from baseline in the NOTES group (+2.4 ± 12.5 versus -6.1 ± 7.0 mmHg, p < 0.001). Mean heart rate increased significantly from baseline in the laparoscopy group compared to the NOTES group (15.0 ± 23.4 versus 3.8 ± 19.0 bpm, p = 0.004). A widening pulse pressure resulted in the NOTES group compared to the laparoscopy group (p < 0.001). The mean bladder pressure was 14.6 ± 8.0 cmH2O in the laparoscopy group compared to 7.1 ± 7.1 cm H2O the NOTES group (p < 0.001). Conclusion: Significant differences in measured but not clinically apparent cardiopulmonary parameters were encountered. The difference in insufflation gas, different vagal or catecholamine response may be contributing to these findings.",
keywords = "Cardiopulmonary parameters, Infection, Laparoscopy, Natural orifice surgery, NOTES, Randomized trial",
author = "Juliane Bingener and Joel Michalek and John Winston and {Van Sickle}, Kent and Vicky Haines and Wayne Schwesinger and Valerie Lawrence",
year = "2008",
month = "6",
doi = "10.1007/s00464-008-9898-8",
language = "English (US)",
volume = "22",
pages = "1430--1434",
journal = "Surgical Endoscopy",
issn = "0930-2794",
publisher = "Springer New York",
number = "6",

}

TY - JOUR

T1 - Randomized blinded trial comparing the cardiopulmonary effects of NOTES with standard laparoscopy in a porcine survival model

AU - Bingener, Juliane

AU - Michalek, Joel

AU - Winston, John

AU - Van Sickle, Kent

AU - Haines, Vicky

AU - Schwesinger, Wayne

AU - Lawrence, Valerie

PY - 2008/6

Y1 - 2008/6

N2 - Background: Anecdotal reports of natural orifice translumenal endoscopic surgery (NOTES) procedures in patients are emerging. Whether the new procedure is truly less invasive is not known. We compared perioperative cardiopulmonary parameters during NOTES with standard laparoscopy. Methods: Twelve swine were randomized to transgastric peritoneoscopy with air or diagnostic laparoscopy with CO2. Cardiopulmonary parameters were invasively monitored. Animals were survived for 14 days. Data were analyzed by an investigator blinded to the procedure performed. Treatments were contrasted on the mean outcome using a repeated measures linear model. Results: All experiments were successfully completed. No gastric leak or peritonitis resulted. Two hundred and fifty cubic centimeters of saline irrigation was adequate to decrease gastric contamination. Respiratory compromise requiring desufflation resulted in two laparoscopy and one endoscopy animal. Mean arterial oxygen saturation remained at baseline for the NOTES group and decreased by 1.5 ± 1.5% in the laparoscopic group (p < 0.001). Mean arterial pH dropped significantly lower in the laparoscopy versus the NOTES group (-0.09 ± 0.06 versus -0.05 ± 0.05, p = 0.01). Mean systolic blood pressure (Sbp) in both groups remained unchanged from the respective baseline (p = 0.45). Mean diastolic blood pressure (Dbp) showed a mean difference of 19 ± 1.5 mmHg between the groups (p < 0.001), increasing from baseline for the laparoscopy group and decreasing significantly from baseline in the NOTES group (+2.4 ± 12.5 versus -6.1 ± 7.0 mmHg, p < 0.001). Mean heart rate increased significantly from baseline in the laparoscopy group compared to the NOTES group (15.0 ± 23.4 versus 3.8 ± 19.0 bpm, p = 0.004). A widening pulse pressure resulted in the NOTES group compared to the laparoscopy group (p < 0.001). The mean bladder pressure was 14.6 ± 8.0 cmH2O in the laparoscopy group compared to 7.1 ± 7.1 cm H2O the NOTES group (p < 0.001). Conclusion: Significant differences in measured but not clinically apparent cardiopulmonary parameters were encountered. The difference in insufflation gas, different vagal or catecholamine response may be contributing to these findings.

AB - Background: Anecdotal reports of natural orifice translumenal endoscopic surgery (NOTES) procedures in patients are emerging. Whether the new procedure is truly less invasive is not known. We compared perioperative cardiopulmonary parameters during NOTES with standard laparoscopy. Methods: Twelve swine were randomized to transgastric peritoneoscopy with air or diagnostic laparoscopy with CO2. Cardiopulmonary parameters were invasively monitored. Animals were survived for 14 days. Data were analyzed by an investigator blinded to the procedure performed. Treatments were contrasted on the mean outcome using a repeated measures linear model. Results: All experiments were successfully completed. No gastric leak or peritonitis resulted. Two hundred and fifty cubic centimeters of saline irrigation was adequate to decrease gastric contamination. Respiratory compromise requiring desufflation resulted in two laparoscopy and one endoscopy animal. Mean arterial oxygen saturation remained at baseline for the NOTES group and decreased by 1.5 ± 1.5% in the laparoscopic group (p < 0.001). Mean arterial pH dropped significantly lower in the laparoscopy versus the NOTES group (-0.09 ± 0.06 versus -0.05 ± 0.05, p = 0.01). Mean systolic blood pressure (Sbp) in both groups remained unchanged from the respective baseline (p = 0.45). Mean diastolic blood pressure (Dbp) showed a mean difference of 19 ± 1.5 mmHg between the groups (p < 0.001), increasing from baseline for the laparoscopy group and decreasing significantly from baseline in the NOTES group (+2.4 ± 12.5 versus -6.1 ± 7.0 mmHg, p < 0.001). Mean heart rate increased significantly from baseline in the laparoscopy group compared to the NOTES group (15.0 ± 23.4 versus 3.8 ± 19.0 bpm, p = 0.004). A widening pulse pressure resulted in the NOTES group compared to the laparoscopy group (p < 0.001). The mean bladder pressure was 14.6 ± 8.0 cmH2O in the laparoscopy group compared to 7.1 ± 7.1 cm H2O the NOTES group (p < 0.001). Conclusion: Significant differences in measured but not clinically apparent cardiopulmonary parameters were encountered. The difference in insufflation gas, different vagal or catecholamine response may be contributing to these findings.

KW - Cardiopulmonary parameters

KW - Infection

KW - Laparoscopy

KW - Natural orifice surgery

KW - NOTES

KW - Randomized trial

UR - http://www.scopus.com/inward/record.url?scp=43749099840&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=43749099840&partnerID=8YFLogxK

U2 - 10.1007/s00464-008-9898-8

DO - 10.1007/s00464-008-9898-8

M3 - Article

C2 - 18398643

AN - SCOPUS:43749099840

VL - 22

SP - 1430

EP - 1434

JO - Surgical Endoscopy

JF - Surgical Endoscopy

SN - 0930-2794

IS - 6

ER -