Division of Gastroenterology and Hepatology, Stanford University Medical Center, M211 Alway Building, 300 Pasteur Drive, MC: 5187, Stanford, CA 94305, USA.
Surg Endosc. 2012 Mar;26(3):747-53. doi: 10.1007/s00464-011-1946-0. Epub 2011 Oct 15.
Natural orifice translumenal endoscopic surgery (NOTES) and laparoendoscopic single-port surgery (LESS) are emerging approaches to abdominal surgery that have been advocated as potentially causing fewer physiologic derangements and less pain. This study aimed to compare these procedures in a novel rat model by assessing peritoneal inflammation, gastric motility, and nociception in response to peritoneoscopy performed via NOTES and LESS.
Adult male rats underwent peritoneoscopy via either transgastric NOTES or LESS using the same type of endoscope and were allowed to recover for 2 to 4 h. Liquid gastric emptying was assessed using phenol red, and cytokine levels were analyzed in peritoneal washings. Thoracic spinal cord segments were stained for Finkel-Biskins-Jinkins osteosarcoma gene (FOS) to assess activation of nociceptive pathways.
The NOTES procedure significantly delayed both postsurgical recovery time compared with LESS (115 ± 25 vs. 82 ± 20 min, respectively; P = 0.04) and liquid gastric emptying (26.7 ± 11.1% vs. 57 ± 10.5%; P = 0.004). Several cytokines such as interleukin-1β (IL-1β), IL-6, monocyte chemoattractant protein-1 (MCP-1), and macrophage inflammatory protein-1 beta (MIP-1β) were significantly elevated in the NOTES group compared with the LESS group. However, the two groups did not differ significantly in spinal FOS activation.
The NOTES approach is feasible in an experimental rat model, facilitating a scientific approach to hypothesis testing through specific methods and instruments. The transgastric NOTES approach in rats is associated with a worse physiologic outcome in terms of gastric motility and peritoneal inflammation but does not differ significantly from LESS in activation of pain pathways.
经自然腔道内镜外科（NOTES）和经腹腔镜单孔手术（LESS）是新兴的腹部手术方法，它们被认为可以减少生理紊乱和疼痛。本研究旨在通过评估经NOTES 和 LESS 行腹膜检查时的腹膜炎症、胃动力和痛觉，在一种新的大鼠模型中比较这两种方法。
成年雄性大鼠通过经胃 NOTES 或 LESS 进行腹膜检查，使用相同类型的内镜，并允许其恢复 2 至 4 小时。使用酚红评估液体胃排空，分析腹膜灌洗液中的细胞因子水平。用 Finkel-Biskins-Jinkins 骨肉瘤基因（FOS）染色胸段脊髓节段，以评估痛觉通路的激活。
与 LESS 相比，NOTES 手术显著延迟了术后恢复时间（分别为 115 ± 25 分钟和 82 ± 20 分钟；P = 0.04）和液体胃排空时间（分别为 26.7 ± 11.1%和 57 ± 10.5%；P = 0.004）。与 LESS 组相比，NOTES 组几种细胞因子如白细胞介素-1β（IL-1β）、IL-6、单核细胞趋化蛋白-1（MCP-1）和巨噬细胞炎症蛋白-1β（MIP-1β）显著升高。然而，两组在脊髓 FOS 激活方面没有显著差异。
NOTES 方法在实验大鼠模型中是可行的，通过特定的方法和仪器为假设检验提供了一种科学的方法。大鼠经胃 NOTES 法与胃动力和腹膜炎症的生理结果较差相关，但与 LESS 相比，其痛觉通路的激活并无显著差异。
