Transvaginal versus Transgastric Endoscopic Peritoneal Approach – a Comparative Experimental Study

TRANSVAGINAL VERSUS TRANSGASTRIC ENDOSCOPIC PERITONEAL APPROACH – A COMPARATIVE ANIMAL STUDY (ABSTRACT): Background: During the last 30 years the advent of laparoscopy and interventional endoscopy induced the emergence of a new approach Natural Orifice Translumenal Endoscopic Surgery (N.O.T.E.S.) in which the peritoneal cavity is accessed through stomach, vagina or other natural orifice, as a even lesser minimally invasive surgery. Method: A total of 8 female pigs (20-35 kg), were assigned to either transgastric or transvaginal endoscopic procedures. General anesthesia with orotracheal intubation was applied following a pre-established protocol in both groups. Transgastric peritoneoscopy, tubal excision and oophorectomy were performed in the first group, and transvaginal liver biopsy and colecistectomy in the second one, with a 14 days follow-up and necropsy at the end of the experiment. Results: All the procedures were successful, with no major intraoperative incidents. Postoperative evolution was uneventful. Necropsy showed mild to moderate peritoneal adhesions in both groups, with small perigastric abscesses in one animal (transgastric-NOTES). No other complications were noted. Conclusions: Both transgastric and transvaginal NOTES procedures are feasible and safe, but should have different indications and limitations. More research and sustained technical development are imperative before clinical implementation.