Evaluation of Bacterial Contamination After Totally Transvaginal Notes Access for Peritoneoscopy and Liver Biopsy in Swine: A Comparative Study With Laparoscopy.

Eduardo Aimore Bonin, MSc, Christiano Marlo Paggi Claus, MSc, Maria F Torres, Veterinarian, Antonio C Campos, PhD, Marcelo De Paula Loureiro, PhD, Antonio Moris Cury Filho, MSc, Gustavo Lopes Carvalho, PhD. Instituto Jacques Perissat (IJP) – Universidade Positivo, Curitiba, Brazil.


 Introduction: For not having skin incisions, totally (or pure) NOTES (natural orifice translumenal endoscopic surgery) has aesthetic advantages and probably less risk of wound complications when compared to conventional laparoscopy. However, bacterial contamination from viscerotomy are potential barriers to NOTES. The aim of this study is to evaluate totally transvaginal NOTES compared to laparoscopic surgery for bacterial contamination, in addition to postoperative outcome. Method: Twelve adult female pigs underwent liver and peritoneal biopsies, either using laparoscopy access (Glap – 6 animals), or totally transvaginal access (GNotes), and survived for 7 days. In all animals, blood cultures were taken at baseline, after 24 hours and 7 days postoperatively. Swab cultures from vagina (Gnotes) and skin (Glap) were obtained before and after antisepsis. Peritoneal fluid culture was obtained at necropsy. For statistical analysis, Fisher`s test was applied with the level of significance set at p<0,05. Results: All animals had good postoperative outcome. Only one animal had a transient peroperative bleeding, from a transvaginal access. All animals from GNotes and Glap presented with mixed flora pre-antisepsis. After antisepsis, only one animal at GNotes presented with a positive vaginal swab culture (a single bacterial strain was identified). There were no positive skin swab culture at Glap. There were no intra-abdominal abnormalities at necropsy. In two animals, one from GLap and another from GNotes, intra-abdominal culture was positive for Corynebacterium spp and Escherichia coli, respectively. There was no correlation between the bacterial flora found at the access site and at the peritoneal cultures. Two animals in GLap and one in GNotes had positive blood cultures after the procedure, and were considered contaminations of the samples. Conclusion: Transvaginal peritoneoscopy is feasible and not associated with increased bacterial contamination compared to laparoscopy in swine. Preoperative antisepsis provided significant reduction on bacterial flora prior to transvaginal and laparoscopic peritoneoscopy.

Key words: Natural orifice translumenal endoscopic surgery, infection, laparoscopy, complications, swine.

Session Number: Poster – Poster Presentations
Program Number: P516
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