Colonic sterilization for natural orifice translumenal endoscopic surgery (NOTES) procedures: a comparison of two decontamination protocols
ABSTRACT BackgroundThis study aimed to evaluate the effect of two different sterilization protocols on the bacterial counts in the swine colon
as preparation for natural orifice translumenal endoscopic surgery (NOTES) surgery.
MethodsIn this study, 16 swine were randomized to two different colonic sterilization protocols: low colonic irrigation using 300ml
of a 1:1 dilution of 10% povidone–iodine (Betadine) with sterile saline, followed by 1g of cefoxitin dissolved in 300ml
of saline or two consecutive 300-ml irrigations using a quaternary ammonium antimicrobial agent (Onamer M). Colonic cultures
were taken before colonic cleansing after a decontamination protocol and after completion of the NOTES procedure. The Invitrogen
live/dead bacterial viability kit was used to assess for change in the bacterial load. A qualitative culture of peritoneal
fluid was obtained at the end of the NOTES procedure. Colon mucosal biopsies obtained immediately after the sterilization
procedure and at the 2-week necropsy point were evaluated for mucosal changes.
ResultsProtocol 1 resulted in an average 93% decrease in live colonic bacteria versus 90% with protocol 2 (nonsignificant difference).
After a NOTES procedure, group 1 had a 62% increase in live bacteria and group 2 had a 31% increase (nonsignificant difference).
Peritoneal cultures also were obtained. Bacteria were isolated from the peritoneal fluid of all the animals, and two or more
species were isolated from 75% of the animals. There was no evidence of peritoneal infection at necropsy. Reactive epithelial
changes and mild inflammation were the only pathologic abnormalities. No changes were noted at histologic evaluation of colonic
mucosa after 2weeks, demonstrating that these were temporary changes.
ConclusionColonic irrigation with Betadine and antibiotics are as effective for bacterial decontamination of the swine colon as a quaternary
ammonium compound. The results of this study support the use of either protocol. Despite thorough decontamination, peritoneal
contamination occurs. The significance of this for humans is unknown.
- SourceAvailable from: Manoel Galvao Neto[Show abstract] [Hide abstract]
ABSTRACT: Applications for natural orifice translumenal endoscopic surgery (NOTES) to access the abdominal cavity have increased in recent years. Despite potential advantages of transanal and transcolonic NOTES for colorectal pathology, it has not been widely applied in the clinical setting. This study describes a series of nine patients for whom we performed transanal retrograde ("Down-to-Up") total mesorectal excision for rectal cancer.Journal of Minimal Access Surgery 07/2014; 10(3):144-50.
- [Show abstract] [Hide abstract]
ABSTRACT: Few studies have evaluated the risk of bacteremia and infectious complications after endoscopic ultrasonography-guided fine needle aspiration (EUS-FNA). Therefore, we aimed to study the frequency of bacteremia and search for a method to potentially reduce bacterial infection after EUS-FNA. We also investigated the effect of taking proton pump inhibitors (PPIs) before examination on the occurrence of bacteremia.Endoscopic ultrasound. 07/2012; 1(2):90-5.
- [Show abstract] [Hide abstract]
ABSTRACT: OBJECTIVES: Clinical natural orifice surgery has been applied for abdominal surgery in recent years. Despite potential advantages of transcolonic NOTES for colorectal diseases, it was since now not yet clinically applied. The study describes the first successful human application of transcolonic NOTES in the literature, in a new transrectal TME procedure for rectal cancer. METHODS: IRB approval was obtained at the institution for the study, and the patient signed informed consent. In a 54yrs-old male patient with a rectal adenocarcinoma, total mesorectal resection and rectosigmoidectomy with lymphadenectomy was performed using a posterior transcolonic access 3cm from the anal verge. Mesorectal dissection was achieved using a flexible colonoscope and endoscopic instrumentation and laparoscopic assistance. The specimen was extracted transanally, and transorificial anastomosis was performed, with proximal stoma. RESULTS: Operative time was 350 min, no intraoperative complications occurred. The postoperative course was uneventful, patient was discharged after 6 days. CONCLUSION: Successful first human report on Transcolonic NOTES potentially brings new fronteers and applications for minimally invasive surgery. The treatment of colorectal diseases through a flexible Perirectal NOTES Access (PNA) is a promising new approach besides existing laparoscopic and open surgery to improve patient care.Revista Brasileira de Coloproctologia 03/2010; 30(1):14-22.