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

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.