Systemic inflammatory response after natural orifice translumenal surgery: transvaginal cholecystectomy in porcine model

Abstract

Background: In the development of laparoscopic surgery, tremendous research was performed to address the immunological and inflammatory response following laparoscopy. Theoretically, with the lesser degree of trauma induced by NOTES, less perioperative proinflammatory response would be expected. In the current study, we aimed to study the systemic inflammatory responses associated with transvaginal cholecystectomy in porcine model. Objective: To study circulating TNF-α and IL-6 after transvaginal Cholecystectomy in porcine model. Methods: Six female pigs were used for survival study after transvaginal cholecystectomy using endoscopic submucosal dissection (ESD) instruments and single channel endoscope. Blood was drawn pre-operatively and within 24 to 48 hours post-operatively. Another four pigs were used as control without intervention. Circulating serum TNF-α and IL-6 were measured 24-48 hours after the operation. Results: In all six pigs in the treatment group, no major intra-operative complication occurred. The median post-operative TNF-α level for control group was 65.97 pg/ml (range 52.75-80.78 pg/ml) whereas transvaginal cholecystectomy group was 66.35 pg/ml (range 40.23-71.65 pg/ml). With Mann-Whitney test, there was no significant difference between 2 groups (p= 0.67). In addition, there was no significant difference between IL-6 level in operated group and control group with the mean of 57.04 pg/ml to 51.22 pg/ml (p=0.45; Mann-Whitney test) with range of 49.47-93.78 pg/ml and 49.5-102.01 pg/ml respectively. Conclusions: NOTES is safe in animal models in terms of anatomical and cellular level with minimal systemic inflammatory host responses elicited. Further study need to be carried out in human before generalization as daily routines.