Comparison of Hybrid Natural Orifice Transluminal Endoscopic Surgery and Single-Port Laparoscopic Surgery for Sentinel Node Basin Dissection in a Porcine Model

Abstract

Background: The aim of the present study was to use a porcine model to compare one-and two-port transvaginal natural orifice transluminal endoscopic surgery (NOTES) with single-port laparoscopic surgery (SPLS) for sentinel node basin dissection. Study Design: Three groups (n=3 per group) of healthy female pigs were subjected to lymph node dissection. For hybrid NOTES, an endoscope was inserted via the transvaginal route. For SPLS, a 5-mm 30 degrees telescope with two-port laparoscopic instrument was inserted via the transumbilical port. The three methods were used to dissect the regions of the pig stomach that corresponded to four lymph node areas on the lesser curvature of the anterior wall and greater curvatures in humans. Results: For two-port NOTES, SPLS, and one-port NOTES, the overall rates of complete dissection of the lymph node stations were 91.6%, 83%, and 50%, respectively (P>.05). The mean resected tissue weights were 49.3, 37.9, and 22.5 g, respectively (P=.03). The mean operation times for two-port NOTES (69.9 minutes) and SPLS (68 minutes) were shorter than that for one-port NOTES (99 min) (P>.05). Conclusion: Two-port NOTES and SPLS are more feasible than one-port NOTES for sentinel node basin dissection in a porcine model. One-port NOTES is difficult to perform and requires long operation times; however, we foresee this operation as becoming more common in the future.