Download PDF
Endoscopy 2012; 44(07): 684-689
DOI: 10.1055/s-0032-1309390
Original article
© Georg Thieme Verlag KG Stuttgart · New York

Transvaginal access for NOTES: a cohort study of microbiological colonization and contamination

G. R. Linke
1   Department of General, Visceral, and Transplant Surgery, University of Heidelberg, Heidelberg, Germany
,
I. Tarantino
2   Department of Surgery, Kantonsspital St. Gallen, St. Gallen, Switzerland
,
T. Bruderer
3   Institute of Clinical Microbiology and Immunology, Kantonsspital St. Gallen, St. Gallen, Switzerland
,
J. Celeiro
2   Department of Surgery, Kantonsspital St. Gallen, St. Gallen, Switzerland
,
R. Warschkow
2   Department of Surgery, Kantonsspital St. Gallen, St. Gallen, Switzerland
4   Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
,
P. E. Tarr
5   Infectious Disease Service, Kantonsspital Bruderholz, Bruderholz, Switzerland
,
B. P. Müller-Stich
1   Department of General, Visceral, and Transplant Surgery, University of Heidelberg, Heidelberg, Germany
,
A. Zerz
6   Department of Surgery, Kantonsspital Bruderholz, Bruderholz, Switzerland
› Author Affiliations
Further Information

Publication History

submitted 02 November 2011

accepted after revision 28 February 2012

Publication Date:
23 April 2012 (online)

Also available at
    Permissions and Reprints

See also:

Commentaire de travail de G. R. Linke et al., pp. 684Endoscopy 2012; 44(07): 718-718
DOI: 10.1055/s-0032-1309988

Background and study aims: Animal data and limited clinical evidence suggest a low incidence of infection following transvaginal natural orifice transluminal endoscopic surgery (NOTES). However, a systematic microbiological evaluation has not yet been carried out. The aim of this prospective cohort study was to evaluate the extent of microbiological contamination of the peritoneal cavity caused by the transvaginal access for NOTES and the impact of preoperative vaginal disinfection on vaginal colonization.

Patients and methods: Consecutive female patients with symptomatic cholecystolithiasis were offered either transvaginal rigid-hybrid cholecystectomy (tvCCE) or conventional laparoscopic cholecystectomy. Patients who opted for tvCCE were prospectively evaluated between February and June 2010. Disinfection in patients undergoing tvCCE included hexetidine tablets and octenidine applied vaginally. All patients received a single dose of perioperative cefuroxime. Swabs were obtained from the posterior fornix and the peritoneal cavity at different intervals.

Results: Of 32 patients, 27 (84 %) opted to undergo tvCCE. One patient (4 %; 95 % confidence interval [CI] 0.7 % – 18.3 %) had a positive bacterial culture in the Douglas pouch prior to transvaginal access compared with two patients (7 %; 95 %CI 2.1 % – 23.4 %) following colpotomy closure (P = 1.000). Vaginal disinfection significantly decreased vaginal bacterial load (P = 0.001) and bacterial growth in routine cultures (P < 0.001); in 16 patients (59 %; 95 %CI 40.7 % – 75.5 %) vaginal swabs were sterile after disinfection. No postoperative surgical site infections occurred (95 %CI 0 % – 12.5 %).

Conclusions: In selected patients and following vaginal antisepsis, transvaginal access for NOTES is associated with microbiological contamination of the peritoneal cavity in a minority of patients, indicating a low risk of peritoneal contamination caused by the transvaginal access.

 

  • References

  • 1 Rattner D, Kalloo A. ASGE/SAGES Working Group on Natural Orifice Translumenal Endoscopic Surgery. October 2005. Surg Endosc 2006; 20: 329-333
    CrossrefPubMedGoogle Scholar
  • 2 Kantsevoy SV. Infection prevention in NOTES. Gastrointest Endosc Clin N Am 2008; 18: 291-296
    CrossrefPubMedGoogle Scholar
  • 3 Zornig C, Mofid H, Siemssen L et al. Transvaginal NOTES hybrid cholecystectomy: feasibility results in 68 cases with mid-term follow-up. Endoscopy 2009; 41: 391-394
    Article in Thieme ConnectPubMedGoogle Scholar
  • 4 Zorron R, Maggioni LC, Pombo L et al. NOTES transvaginal cholecystectomy: preliminary clinical application. Surg Endosc 2008; 22: 542-547
    CrossrefPubMedGoogle Scholar
  • 5 Linke GR, Tarantino I, Hoetzel R et al. Transvaginal rigid-hybrid NOTES cholecystectomy: evaluation in routine clinical practice. Endoscopy 2010; 42: 571-575
    Article in Thieme ConnectPubMedGoogle Scholar
  • 6 Federlein M, Borchert D, Muller V et al. Transvaginal video-assisted cholecystectomy in clinical practice. Surg Endosc 2010; 24: 2444-2452
    CrossrefPubMedGoogle Scholar
  • 7 Pugliese R, Forgione A, Sansonna F et al. Hybrid NOTES transvaginal cholecystectomy: operative and long-term results after 18 cases. Langenbecks Arch Surg 2009; 395: 241-245
    PubMedGoogle Scholar
  • 8 Ramos AC, Murakami A, Galvao NM et al. NOTES transvaginal video-assisted cholecystectomy: first series. Endoscopy 2008; 40: 572-575
    Article in Thieme ConnectPubMedGoogle Scholar
  • 9 Park JS, Choi GS, Lim KH et al. Clinical outcome of laparoscopic right hemicolectomy with transvaginal resection, anastomosis, and retrieval of specimen. Dis Colon Rectum 2010; 53: 1473-1479
    CrossrefPubMedGoogle Scholar
  • 10 Lacy AM, Delgado S, Rojas OA et al. MA-NOS radical sigmoidectomy: report of a transvaginal resection in the human. Surg Endosc 2008; 22: 1717-1723
    CrossrefPubMedGoogle Scholar
  • 11 Tarantino I, Linke GR, Lange J et al. Transvaginal rigid-hybrid natural orifice transluminal endoscopic surgery technique for anterior resection treatment of diverticulitis: a feasibility study. Surg Endosc 2011; 25: 3034-3042
    CrossrefPubMedGoogle Scholar
  • 12 ACOG practice bulletin No. 104: antibiotic prophylaxis for gynecologic procedures. Obstet Gynecol 2009; 113: 1180-1189
    PubMedGoogle Scholar
  • 13 Isenberg HD. Clinical microbiology procedures handbook. ASM Press, Washington DC 2004
    PubMedGoogle Scholar
  • 14 Murray PR, Baron EJ, Jorgensen JH et al. Manual of clinical microbiology. Washington DC: ASM Press 2007
    PubMedGoogle Scholar
  • 15 Nieboer TE, Johnson N, Lethaby A et al. Surgical approach to hysterectomy for benign gynaecological disease. Cochrane Database Syst Rev 2009; CD003677
    PubMedGoogle Scholar
  • 16 Watrelot A. Place of transvaginal fertiloscopy in the management of tubal factor disease. Reprod Biomed Online 2007; 15: 389-395
    CrossrefPubMedGoogle Scholar
  • 17 Zornig C, Siemssen L, Emmermann A et al. NOTES cholecystectomy: matched-pair analysis comparing the transvaginal hybrid and conventional laparoscopic techniques in a series of 216 patients. Surg Endosc 2010; 25: 1822-1826
    PubMedGoogle Scholar
  • 18 Lehmann KS, Ritz JP, Wibmer A et al. The German registry for natural orifice translumenal endoscopic surgery: report of the first 551 patients. Ann Surg 2010; 252: 263-270
    CrossrefPubMedGoogle Scholar
  • 19 Zorron R, Palanivelu C, Galvao Neto MP et al. International multicenter trial on clinical natural orifice surgery – NOTES IMTN study: preliminary results of 362 patients. Surg Innov 2010; 17: 142-158
    CrossrefPubMedGoogle Scholar
  • 20 Lomanto D, Chua HC, Myat MM et al. Microbiological contamination during transgastric and transvaginal endoscopic techniques. J Laparoendosc Adv Surg Tech A 2009; 19: 465-469
    CrossrefPubMedGoogle Scholar
  • 21 Yang QY, Zhang GY, Wang L et al. Infection during transgastric and transvaginal natural orifice transluminal endoscopic surgery in a live porcine model. Chin Med J (Engl) 2011; 124: 556-561
    PubMedGoogle Scholar
  • 22 Powell B, Whang SH, Bachman SL et al. Transvaginal repair of a large chronic porcine ventral hernia with synthetic mesh using NOTES. JSLS 2010; 14: 234-239
    CrossrefPubMedGoogle Scholar
  • 23 Huebner J, Goldmann DA. Coagulase-negative staphylococci: role as pathogens. Annu Rev Med 1999; 50: 223-236
    CrossrefPubMedGoogle Scholar
  • 24 Enzelsberger H, Eppel W, Dorninger G et al. [Efficacy of various methods for preoperative vaginal antisepsis]. Geburtshilfe Frauenheilkd 1995; 55: 707-710
    Article in Thieme ConnectPubMedGoogle Scholar
  • 25 Dettenkofer M, Jonas D, Wiechmann C et al. Effect of skin disinfection with octenidine dihydrochloride on insertion site colonization of intravascular catheters. Infection 2002; 30: 282-285
    CrossrefPubMedGoogle Scholar
  • 26 Turovskiy Y, Sutyak NK, Chikindas ML. The aetiology of bacterial vaginosis. J Appl Microbiol 2011; 110: 1105-1128
    CrossrefPubMedGoogle Scholar
  • 27 Cuadrado-Garcia A, Noguera JF, Olea-Martinez JM et al. Hybrid natural orifice transluminal endoscopic cholecystectomy: prospective human series. Surg Endosc 2011; 25: 19-22
    CrossrefPubMedGoogle Scholar
  • 28 ACOG practice bulletin No. 104: antibiotic prophylaxis for gynecologic procedures. Obstet Gynecol 2009; 113: 1180-1189
    PubMedGoogle Scholar