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

Journal Paper/Review - Apr 23, 2012

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Citation
Linke G, Tarantino I, Bruderer T, Celeiro J, Warschkow R, Tarr P, Müller-Stich B, Zerz A. Transvaginal access for NOTES: a cohort study of microbiological colonization and contamination. Endoscopy 2012; 44:684-9.
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Type
Journal Paper/Review (English)
Journal
Endoscopy 2012; 44
Publication Date
Apr 23, 2012
Issn Print
Issn Electronic
1438-8812
Pages
684-9
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Brief description/objective

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.