Natural Orifice Translumenal Endoscopic Surgery (NOTES) Peritoneoscopy Versus Laparoscopy to evaluate Intra-Abdominal Pathology in a Porcine Model

Background: The decision to operate on the intensive care patient with a questionable abdominal source of sepsis continues to prove difficult despite advancements in radiographic imaging. We believe a bedside trans-gastric NOTES exploration could be a valuable diagnostic tool in this setting.
Methods: An acute, non-survival, study of 8 pigs was performed. Pigs were randomized to demonstrate from 0 to 4 common intra-abdominal lesions: small bowel ischemia (SBI), Small bowel perforation (SBP), Recto-sigmoid colon perforation (CP), and gangrenous cholecystitis (GC). Two blinded surgeons were allowed 60 minutes to perform NOTES or laparoscopy to locate lesions and identify their presence or absence correctly.
Results: Laparoscopy was found to be more sensitive for detecting SBI and SBP. NOTES was consistently more specific with 100% positive predictive value for all lesions. It, however, was found to be weakest in identifying SBP with a poor negative predictive value of 57.1%.

Conclusion: Our findings suggest identification of common life threatening lesions as seen in an ICU setting can be accomplished by NOTES techniques in a porcine model. Identification of gall bladder disease and colonic perforation was comparable to laparoscopy. NOTES, however, was found to be weakest in identifying small bowel lesions where laparoscopy was routinely successful. Further studies will be warranted, though initial data are promising.

Session: Poster

Program Number: P192

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