Disinfection of the Access Orifice in NOTES: Evaluation of the Evidence Base

Table 2

Best available evidence for preparation of orifice for transvaginal, transcolonic, and transvesical access.

Study	Access	Subject	Procedure	Closure	Infection prophylaxis	Outcome
Lehmann et al. [27]	Hybrid transvaginal NOTES/transabdominal laparoscopic	572 humans	Cholecystectomy (488), Appendix (42), other (42)	Direct sutured	Not known	3.3% complication rate for cholecystectomy, 0% for appendix. Conversion rate 4.9% overall. 1 pelvic abscess. 1 wound infection
Niu et al. [28]	Hybrid transvaginal NOTES/transabdominal laparoscopic	43 humans	Cholecystectomy (488), Appendix (42), other (42)	Direct sutured	Systemic antibiotics, local disinfection not known	No complications reported
Bachman et al. [21]	Transcolonic	16 pigs	Peritoneoscopy	Tissue Approximation System (Ethicon Endo-Surgery, Inc.)	Comparison of antibiotic/antiseptic irrigation and quaternary ammonium solution	Effective disinfection, no infection on necropsy, no difference between treatment arms
Ryou et al. [22]	Transcolonic	8 pigs	Peritoneoscopy	Prototype device	Irrigation with tapwater antibiotics and antiseptic	No evidence of infection on necropsy
Lima et al. [32]	Transvesical	8 pigs	Peritoneoscopy	None	None noted	No evidence of infection on necropsy
McGee et al. [34]	Hybrid transvesical NOTES/transabdominal laparoscopic	1 human	NOTES peritoneoscopy, robotic prostatectomy	Direct sutured	None noted	No complications reported