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No-incision (NOTES) versus single-incision (single-port) surgery for access to sites of peritoneal carcinomatosis: a back-to-back animal study

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Abstract

Background

Preoperative radiological diagnosis and evaluation of limited peritoneal carcinomatosis (PC) is suboptimal. Triangle laparoscopy is considered a noncarcinologic option due to the risk of tumoral spreading through the lateral ports into the abdominal wall muscles. Open surgery is therefore often needed to characterize PC. A minimally invasive approach would be progress.

Methods

We aimed to compare access rates to elective sites of PC using natural orifice transluminal endoscopic surgery (NOTES) with those using single-port laparoscopic surgery (SPLS). Sixteen acute experiments were performed in a live porcine model. Back-to-back NOTES and SPLS standardized peritoneoscopy were conducted in a cross-over design. Access rates to 11 elective sites of PC were considered as end points based on operators’ consensus and necropsy verification.

Results

Access to the targets was successful in 89 % with NOTES and 80 % with SPLS (p = 0.27). NOTES and SPLS achieved a 100 % access rate to the diaphragmatic domes and paracolic gutters, to the splenic area, to the pelvic floor, and to the trigonal bladder (p > 0.99). Access rates of NOTES versus SPLS to other elective sites of PC were the following: mesentery root (94 % vs. 0 %, p < 0.001), inferior mesenteric vein origin (88 % vs. 0 %, p < 0.001), inferior vena cava (88 % vs. 75 %, p = 0.85), and hepatic pedicle (8 % vs. 100 %, p < 0.001).

Conclusions

Both transgastric NOTES and SPLS provided quick and easy access to most elective sites of PC, except for the mesenteric vessel root (better achieved by NOTES) and the hepatic pedicle (better achieved by SPLS). Both techniques could be improved or combined to overcome their specific drawbacks.

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Abbreviations

CT:

Computed tomography

HIPEC:

Hyperthermic intraperitoneal chemotherapy

NOTES:

Natural orifice transluminal endoscopic surgery

PC:

Peritoneal carcinomatosis

SPLS:

Single-port laparoscopic surgery

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Acknowledgments

The authors thank Karl Storz Endoscopy (Tuttlingen, Germany) which provided the endoscopic and laparoscopic equipment free of charge, and Covidien (Mansfield, MA, USA) which provided the SILS™ port free of charge. This work was funded by a grant by the EuroNOTES Ethicon Endo-Surgery Research Fund Project.

Disclosures

Yamina Ladjici received a grant from the association Benoit Malassagne, Paris, France, to support her research on minimally invasive surgical and endoscopic techniques. M. Pocard, P. Marteau, P. Valleur, and X. Dray have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Assistance Publique-Hôpitaux de Paris (APHP), Department of Digestive Diseases, Tertiary Care Centre for Peritoneal Carcinomatosis, Lariboisière Hospital, School of Surgery, and Denis Diderot, Paris 7 University, 2, rue Ambroise Paré, 75010, Paris, France

    Yamina Ladjici, Marc Pocard, Philippe Marteau, Patrice Valleur & Xavier Dray

  2. INSERM Unit 965, Paris, France

    Yamina Ladjici, Marc Pocard & Xavier Dray

  3. Laboratoire EA 3199, Conservatoire National des Arts et Métiers, Paris, France

    Philippe Marteau & Xavier Dray

  4. Division of Gastroenterology, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Xavier Dray

Authors
  1. Yamina Ladjici
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  2. Marc Pocard
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  3. Philippe Marteau
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  4. Patrice Valleur
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  5. Xavier Dray
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Corresponding author

Correspondence to Xavier Dray.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Video 1 Transgastric NOTES for access to elective sites of peritoneal carcinomatosis (MPG 10064 kb)

Video 2 Single-port laparoscopic surgery for access to sites of peritoneal carcinomatosis (MPG 10300 kb)

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Ladjici, Y., Pocard, M., Marteau, P. et al. No-incision (NOTES) versus single-incision (single-port) surgery for access to sites of peritoneal carcinomatosis: a back-to-back animal study. Surg Endosc 26, 2658–2666 (2012). https://doi.org/10.1007/s00464-012-2251-2

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