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Ricard Navarro-Ripoll,
Graciela Martínez-Pallí,
Carlos Guarner-Argente,
Henry Córdova,
Maria Angels Martínez-Zamora, Jaume Comas,
Cristina Rodríguez de Miguel,
Mireia Beltrán,
Antonio Rodríguez-D'Jesús,
Clara Hernández-Cera,
Josep Llach,
Jaume Balust,
Glòria Fernández-Esparrach
[show abstract]
[hide abstract]
ABSTRACT: Endoscopic insufflation has been associated with marked increase in intra-abdominal pressure (IAP) and hemodynamic and respiratory changes during transgastric surgery.
To investigate the hemodynamic and respiratory effects during intraperitoneal cavity exploration through 3 different natural orifice transluminal endoscopic surgery (NOTES) access locations compared with laparoscopy.
Survival experiments using 40 female pigs randomized to transgastric, transcolonic, transvaginal, and laparoscopic peritoneoscopy.
On-demand endoscopic insufflation of CO(2) with feedback pressure regulation was used in NOTES with a maximum pressure of 14 mm Hg. In the laparoscopy group, the IAP was maintained at 14 mm Hg. NOTES procedures were performed by an endoscopist (with the assistance of a gynecologist in the transvaginal group and a second endoscopist in the transgastric and transrectal groups) and laparoscopy by 2 surgeons.
Invasive hemodynamic and respiratory data. Blood samples were drawn for gas analyses.
All experiments except one in the transrectal group were completed. The IAP was significantly lower in all NOTES groups compared with the laparoscopy group. A significant increase in mean systemic arterial blood pressure was observed in the laparoscopy group at 15 and 30 minutes of intraperitoneal cavity exploration, but it remained unchanged during all NOTES procedures. An increase in airway pressures was observed at 15 and 30 minutes of peritoneoscopy in the animals undergoing laparoscopy, whereas those parameters remained unchanged in the NOTES groups. The laparoscopy group showed a significant impairment in pulmonary gas exchange (decrease in Pao(2), increase in Paco(2), and decrease in arterial pH) after 30 minutes of peritoneoscopy, whereas only a slight increase in Paco(2) was observed in the transrectal and transvaginal groups.
Healthy animal model.
On-demand endoscopic insufflation of CO(2) with feedback pressure regulation can minimize the risk of hemodynamic and respiratory compromise caused by acute changes in IAP.
Gastrointestinal endoscopy 08/2012; 76(2):388-95. · 6.71 Impact Factor
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Carlos Guarner-Argente,
Graciela Martínez-Pallí,
Ricard Navarro-Ripoll,
Henry Córdova,
Mireia Beltrán,
M. Àngels Martínez-Zamora, Jaume Comas,
Cristina Rodríguez de Miguel,
Antonio Rodríguez-D’Jesús,
Xavier Filella,
Clara Hernández-Cera,
Antonio M. Lacy,
Christopher C. Thompson,
Gloria Fernández-Esparrach
[show abstract]
[hide abstract]
ABSTRACT: BackgroundInflammatory changes of different NOTES approaches remain unknown. The aim of this study was to compare the inflammatory effects
of NOTES and laparoscopy.
MethodsForty female pigs were assigned to transgastric, transrectal, and transvaginal NOTES and laparoscopic peritoneoscopy groups.
Antiseptic technique was utilized for NOTES whereas laparoscopy was performed sterile. Intraperitoneal pressures were monitored
and maintained below 15mmH2O. Pneumoperitoneum was maintained with CO2 in all groups. Pre- and postoperative blood samples of IL-6, Il-1β, and TNFα, and peritoneal fluid collected at surgery were
analyzed. Animals were followed daily for 14days. At necropsy, peritoneal fluid was collected for cytokine analysis.
ResultsThirty-nine peritoneoscopies were successfully completed. The median procedure time was longer in the NOTES groups (57min,
range=33–109) than in the laparoscopy group (33min, range 32–36; P<0.001); this was related to longer incision time and closure time. All 39 completed follow-up. Severe bleeding in the post-transrectal
approach required early sacrifice of the remaining animal. Besides this, complications were similar among groups. At necropsy,
adhesions were seen in four animals in the gastric group, five in the rectal group, two in the vaginal group, and two in the
laparoscopic group (P=ns). There were no statistical differences in serum levels of TNFα among the groups. When serum TNFα values were expressed
as the difference from the baseline, in the transvaginal group they were significantly lower than in the transrectal at 2h
[0.5pg/ml (range=−14 to 59) vs. 60pg/ml (range=−8 to 303); P=0.041] and at 8h [−5.5pg/ml (range=−86 to 55] vs. 37pg/ml (range=−30 to 62); P=0.031]. The limitations of this study were that the analyses of IL-6 and Il-1β were not possible because most of the samples
were below detectable levels, it was an animal model, and the sample size was small.
ConclusionInflammatory parameters are similar between NOTES and laparoscopic peritoneoscopy despite longer surgery time in the NOTES
group. The vaginal route seems to reduce the inflammatory stress.
KeywordsNOTES–Inflammatory–Peritoneoscopy–TNFα–Porcine–Survival
Surgical Endoscopy 04/2012; 26(2):374-380. · 4.01 Impact Factor
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Henry Córdova,
Carlos Guarner-Argente,
Graciela Martínez-Pallí,
Ricard Navarro,
Antonio Rodríguez-D'Jesús,
Cristina Rodríguez de Miguel,
Mireia Beltrán,
M Àngels Martínez-Zamora, Jaume Comas,
Antonio M Lacy,
Christopher C Thompson,
Gloria Fernández-Esparrach
[show abstract]
[hide abstract]
ABSTRACT: The aim of this study was to evaluate the restoration of gastrointestinal motility after NOTES using capsule endoscopy (CE).
Twenty adult Yorkshire pigs were randomly assigned to four groups: transgastric NOTES (gNOTES), transrectal NOTES (rNOTES), transvaginal NOTES (vNOTES), and laparoscopy (LAP). At the end of a 30-min peritoneoscopy with identification of seven predetermined organs, an array of eight receivers and the recorder were attached to the abdominal wall. The CE was delivered into the antrum with the help of an endoscope and a polypectomy snare. Animals were kept alive for 14 d.
Median time for surgery was longer in gNOTES (56 min, range 47-63) and vNOTES (54 min, range 44-79) than in LAP (32 min, range 32-33; P < 0.05 and P < 0.01) and in rNOTES (45.5 min, range 33-56) (P = ns). This increase was related to a larger incision and longer closure times. Images from the CE were successfully retrieved in 19 cases. The CE was retained in the stomach in all animals in gNOTES (459 min; range 360-600), but only in one animal in rNOTES and vNOTES and in none in the LAP group. Failure of passage of the CE beyond the stomach was associated with gNOTES and longer closure of the incision. Animals in the gNOTES group gained less weight than the others and this change was statistical significant when compared with vNOTES animals (1.7 kg, range -1.98 to 4.5 versus 8.4 kg, range 5.8 to 11.45; P < 0.01).
Gastric emptying is delayed after gNOTES peritoneoscopy compared with rNOTES, vNOTES, and LAP and this effect is associated with less weight gain.
Journal of Surgical Research 11/2011; 174(2):e61-7. · 2.25 Impact Factor
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Carlos Guarner-Argente,
Graciela Martínez-Pallí,
Ricard Navarro-Ripoll,
Henry Córdova,
Mireia Beltrán,
M Angels Martínez-Zamora, Jaume Comas,
Cristina Rodríguez de Miguel,
Antonio Rodríguez-D'Jesús,
Xavier Filella,
Clara Hernández-Cera,
Antonio M Lacy,
Christopher C Thompson,
Gloria Fernández-Esparrach
[show abstract]
[hide abstract]
ABSTRACT: Inflammatory changes of different NOTES approaches remain unknown. The aim of this study was to compare the inflammatory effects of NOTES and laparoscopy.
Forty female pigs were assigned to transgastric, transrectal, and transvaginal NOTES and laparoscopic peritoneoscopy groups. Antiseptic technique was utilized for NOTES whereas laparoscopy was performed sterile. Intraperitoneal pressures were monitored and maintained below 15 mmH(2)O. Pneumoperitoneum was maintained with CO(2) in all groups. Pre- and postoperative blood samples of IL-6, Il-1β, and TNFα, and peritoneal fluid collected at surgery were analyzed. Animals were followed daily for 14 days. At necropsy, peritoneal fluid was collected for cytokine analysis.
Thirty-nine peritoneoscopies were successfully completed. The median procedure time was longer in the NOTES groups (57 min, range = 33-109) than in the laparoscopy group (33 min, range 32-36; P < 0.001); this was related to longer incision time and closure time. All 39 completed follow-up. Severe bleeding in the post-transrectal approach required early sacrifice of the remaining animal. Besides this, complications were similar among groups. At necropsy, adhesions were seen in four animals in the gastric group, five in the rectal group, two in the vaginal group, and two in the laparoscopic group (P = ns). There were no statistical differences in serum levels of TNFα among the groups. When serum TNFα values were expressed as the difference from the baseline, in the transvaginal group they were significantly lower than in the transrectal at 2 h [0.5 pg/ml (range = -14 to 59) vs. 60 pg/ml (range = -8 to 303); P = 0.041] and at 8 h [-5.5 pg/ml (range = -86 to 55] vs. 37 pg/ml (range = -30 to 62); P = 0.031]. The limitations of this study were that the analyses of IL-6 and Il-1β were not possible because most of the samples were below detectable levels, it was an animal model, and the sample size was small.
Inflammatory parameters are similar between NOTES and laparoscopic peritoneoscopy despite longer surgery time in the NOTES group. The vaginal route seems to reduce the inflammatory stress.
Surgical Endoscopy 09/2011; 26(2):374-80. · 4.01 Impact Factor
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Josep Martí,
María Marta Modolo,
Josep Fuster, Jaume Comas,
Rebeca Cosa,
Joana Ferrer,
Victor Molina,
Juan Romero,
Constantino Fondevila,
Ramón Charco,
Juan Carlos García-Valdecasas
[show abstract]
[hide abstract]
ABSTRACT: To analyze the prognostic factors involved in survival and cancer recurrence in patients undergoing surgical treatment for colorectal liver metastases (CLM) and to describe the effects of time-related changes on survival and recurrence in these patients.
From January 1994 to January 2006, 236 patients with CLM underwent surgery with the aim of performing curative resection of neoplastic disease at our institution and 189 (80%) of these patients underwent resection of CLM with curative intention. Preoperative, intraoperative and postoperative data, including primary tumor and CLM pathology results, were retrospectively reviewed. Patients were divided into two time periods: a first period from January 1994 to January 2000 (n = 93), and a second period from February 2000 to January 2006 (n = 143).
Global survival at 1, 3 and 5 years in patients undergoing hepatic resection was 91%, 54% and 47%, respectively. Patients with preoperative extrahepatic disease, carcinoembryonic antigen (CEA) levels over 20 ng/dL, more than four nodules or extrahepatic invasion at pathological analysis had worse survival. Tumor recurrence rate at 1 year was 48.3%, being more frequent in patients with preoperative and pathological extrahepatic disease and CEA levels over 20 ng/dL. Although patients in the second time period had more adverse prognostic factors, no differences in overall survival and recurrence were observed between the two periods.
Despite advances in surgical technique and better adjuvant treatments and preoperative imaging, careful patient staging and selection is crucial to continue offering a chance of cure to patients with CLM.
World Journal of Gastroenterology 07/2009; 15(21):2587-94. · 2.47 Impact Factor
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[show abstract]
[hide abstract]
ABSTRACT: The standard surgical procedure for intraductal papillary mucinous neoplasms of the main duct (IPMN-M) or side branch ducts (IPMN-Br) is pancreaticoduodenectomy. IPMN-BR is a more indolent disease with a lower incidence of malignancy.
To evaluate the usefulness of organ-preserving pancreatic resections (OPPR) including duodenum-preserving pancreatic head resection (DPHR) and pancreatic head resection with segmental duodenectomy (PHRSD) in patients with IPMN-BR.
Surgical outcomes were evaluated in eight IPMN-Br patients: DPHR was performed in 4 patients and PHRSD was performed in 4 patients. In addition, 13 IPMN patients with Whipple resections were included in the analysis.
The incidence of postoperative complications was 38% after Whipple resection, 100% after DPHR and 25% after PHRSD. The mean length of hospital stay was 27 days after DPHR, 22 days after Whipple resection and 16 days after PHRSD. Invasive IPMN was found in 38% of the patients in the Whipple group, and noninvasive IPMN was found in 100% of patients who underwent organ-preserving surgery.
Pancreaticoduodenectomy remains the treatment of choice in patients with invasive IPMN. PHRSD appears to be a useful procedure for IPMN-Br located in the head of the pancreas.
Cirugía Española 12/2006; 80(5):295-300. · 0.87 Impact Factor
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[show abstract]
[hide abstract]
ABSTRACT: Human rotaviruses are considered the main cause of viral gastroenteritis in infants and young children throughout the world. Their transmission is through the fecal-oral route, mostly after ingestion of contaminated water and food. Since an extremely high number of virus particles are present in the feces during the acute gastroenteritis, methods based on electron microscopy, passive particle agglutination tests, or enzyme-linked immunosorbent assays are readily employed for clinical diagnosis. However, the sensitivity of these procedures is not high enough to detect the low number of viral particles sometimes present in the environment. In the case of environmental samples, amplification of viral nucleic acids by polymerase chain reaction assays coupled to reverse transcription (RT-PCR) has been increasingly applied to detect rotaviruses in water and shellfish samples. However, procedures based on molecular approaches have to face the drawback that they do not differentiate between infectious and noninfectious particles, which is of major relevance from the public health point of view. Virus propagation in cell culture prior to detection by immunological or molecular procedures accomplishes the dual purpose of increasing the amount of target material and incorporating an infectivity assay as well.Wild-type rotaviruses present difficulties in their in vitro replication, although some of them may be adapted to grow in several cell lines such as the monkey kidney cell line MA104 or the human intestinal cell line CaCo-2. More than a decade ago, an assay for the specific detection of infectious rotaviruses in environmental samples, involving an indirect immunofluorescence test (IIF) and optical microscopy (OM) counting of infected foci in infected MA-104 cell monolayers, was described. On the other hand, CaCo-2 cells have been successfully employed in our laboratory for infectivity assays of several fastidious enteric virus strains present in water samples.
Methods in molecular biology (Clifton, N.J.) 02/2004; 268:61-8.
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Carlos Guarner-Argente,
Mireia Beltrán,
Graciela Martínez-Pallí,
Ricard Navarro-Ripoll,
M Àngels Martínez-Zamora,
Henry Córdova, Jaume Comas,
Cristina Rodríguez de Miguel,
Antonio Rodríguez-D'Jesús,
Manel Almela,
Clara Hernández-Cera,
Antonio M Lacy,
Gloria Fernández-Esparrach
[show abstract]
[hide abstract]
ABSTRACT: Infection in natural orifice transluminal endoscopic surgery (NOTES) remains controversial.
To estimate the frequency of infection during NOTES peritoneoscopy with different routes of access and to compare with laparoscopy.
Prospective randomized controlled study (Canadian Classification type I).
Forty female pigs were randomly assigned to 3 NOTES (transgastric, transrectal, and transvaginal) and laparoscopic groups. Antiseptic technique was used for NOTES, whereas laparoscopy was performed in a sterile environment. Preoperative and postoperative intravenous antibiotics were administered. Closure of the transluminal access site was performed in all animals. Peritoneal fluid was collected for culture at the end of surgery and at necropsy at day 14.
Thirty-nine peritoneoscopies were successfully completed. Necropsy confirmed complete healing of NOTES incisions, but 2 animals in the laparoscopy group had small abscesses in the abdominal incisions. There were no statistical differences in the presence of peritoneal adhesions. Positive culture results were seen in all groups at the end of the procedure and in all animals at necropsy, but this did not lead to clinical signs of gross infection. The most common organisms that colonized the peritoneum were gram-positive cocci and gram-negative bacilli from the normal swine gastrointestinal flora.
Animal model and small sample size.
In these small series of animals and with the careful lavage and preparation used, NOTES appeared to be comparable to laparoscopy in terms of peritoneal contamination and clinical infection. Despite the adherence to a strict antiseptic protocol, peritoneal contamination occurs but does not lead to septic complications in the swine.
Journal of Minimally Invasive Gynecology 18(6):741-6. · 1.74 Impact Factor
