[Pure transgastric NOTES laparoscopy compared to classic laparoscopy].

INTRODUCTION: NOTES--Natural orifice transluminal endoscopic surgery--represents a new surgical approach. The operation is performed via natural openings of the body without causing any damage to the skin and the abdominal wall. At the Department of Surgery of the University Hospital in Pilsen, we have been performing NOTES since 2008. The first animal experiment was performed in that year by a hybrid NOTES technique.

METHODS: A prospective study was carried out at the animal experimental room of Charles University in Prague, Faculty of Medicine in Pilsen, on domestic pigs under general anaesthesia. 15 pigs were operated on by the transgastric pure NOTES method using double-channel endoscope. Gastrotomy was performed using a needle knife and the stomach was closed by OTSC clips. The control group consisting of 15 pigs was operated on by classic laparoscopy through a 14-mm port with the use of double-channel endoscope. During the following two weeks the animals underwent clinical monitoring and sonographic examinations, and samples for biochemical and microbiological analysis were collected. Post-mortem examination focusing on infectious complications was performed after 14 days.

RESULTS: In comparison with the conventional laparoscopic technique, the transgastric pure NOTES approach has shown similar results. Inflammation in the skin suture appeared in 6 pigs operated on by classic laparascopy. During the clinical and sonography followup as well as in the autopsy of both groups, no signs of focal infection in the abdominal cavity were shown.

CONCLUSION: The pure NOTES approach is very difficult, though not unfeasible to put into practice due to our present technical equipment. The development and implementation of the NOTES access into clinical practice would demand better technical equipment.