| Minimally invasive surgery is an emerging discipline in the development of surgical field, is a milestone in the history of the development of surgery, and is one of the surgical developing directions in the21st century. Laparoscopic surgery is an important part of minimally invasive surgery, the advantages of the laparoscopic surgery is minimally invasive, excellent visualization, less bleeding, less pain, faster recovery and less tissue adhesion. This technology has been fully aware and sure. Laparoscopic surgery has been reported in each part of the digestive tract fistula operation in human medicine, but a slow development of laparoscopic gastrointestinal cannulation in veterinary. At present, we are unaware of a reported method of laparoscopic gastrointestinal cannulation in miniature pigs. Therefore, the purpose of this study was to design and perform a selection trial of the optimum pneumoperitoneum in surgery of miniature pigs; to design and perform laparoscopic gastric cannulation, laparoscopic duodenal cannulation, and laparoscopic ileal cannulation at the optimum CO2pneumoperitoneum pressure; to evaluate the feasibility and security of laparoscopic gastrointestinal cannulation of miniature pigs; to compare the influence of laroscopic and open gastrointestinal cannulation of miniature pigs.The miniature pigs were randomly selected for five groups, six in each group, to perform best pneumoperitoneum pressure screening test. Group A, B, C, D and E were respectively subjected to CO2pneumoperitoneum at pressure OmmHg,6mmHg,8mmHg,10mmHg and12mmHg. Respiratory system, circulatory system, hepatic function, renal function, myocardial enzymes, oxidative stress parameter and neuroendocrine hormone were recorded at time point in each group. The miniature pigs were randomly selected for six groups, six in each group, to perform laparoscopic gastrointestinal cannulation and open gastrointestinal cannulation. Laparoscopic gastric cannulation, laparoscopic duodenal cannulation and laparoscopic ileal cannulation were performed by procedures of pneumoperitoneum, establishment of surgical approaches, viscera lookup under laparoscope, suture fixation, purse-string suture, inserting the fistula, eliciting the fistula and closure of the abdominal cavity. Clinical signs, heart rate, body temperature, systolic blood pressure, diastolic blood pressure, mean arterial pressure, respiratory rate, saturation and end-tidal partial pressure of carbon dioxide were monitored during operation. Intraoperative and postoperative complications, the operation completion, operation time, postoperative mental state, diet, wound healing, the collection of digestive juices and postoperative evaluation of the gastrointestinal cannulation sites were recorded. Ear venous blood samples were obtained after surgery for white blood cell count, Interleukin-6, Interleukin-1β and Tumor necrosis factor-a.Experimental results such as follows, the low pneumoperitoneum pressure was difficult to meet the requirements of observation and operation in the surgery, the high pneumoperitoneum pressure showed surgical field fully, but had bigger influence on the body’s physiological function.10mmHg pneumoperitoneum pressure had little effect on oxidative stress and neuroendocrine of the body. The malondialdehyde and adrenocorticotropic hormone had a significant change. About malondialdehyde, compared with before pneumoperitoneum, there were statistically significant differences from40min to4h after pneumoperitoneum; it was recovery on1day after pneumoperitoneum. About adrenocorticotropic hormone, compared with before pneumoperitoneum, there were statistically significant differences from25min to60min after pneumoperitoneum; it was recovery on10min after pneumoperitoneum. Thus, we determined the best pneumoperitoneum pressure of miniature pigs was1OmmHg, which was not only safe but also suitable for surgery.Laparoscopic gastric cannulation, laparoscopic duodenal cannulation, laparoscopic ileal cannulation and the corresponding open procedure were accomplished successfully in miniature pigs without major intraoperative and postoperative complications. All miniature pigs were alive. With good mental state, no bow and groaning, food consumption and fecal output were normal from the end of the surgery to fistula removal process of all miniature pigs. The fistula sites on the abdominal wall exhibited slight inflammation and that disappeared within5-7d after surgery, without digestive fluid leakage of all miniature pigs. All miniature pigs were useful for sampling digestive fluid. During the repeat laparoscopy, firm fibrous adhesions were present between the serosal surfaces of the stomach, duodenum, ileum and the parietal peritoneum, respectively, with no other abdominal cavity abnormalities.The mean surgical time of laparoscopic gastric cannulation was50min, the total length of all incisions was2.5cm, and the mean surgical time of corresponding open surgery was37.67min, the mean incision length was8cm. The mean surgical time of laparoscopic duodenal cannulation was44.83min, the total length of all incisions was2cm, and the mean surgical time of corresponding open surgery was33min, the mean incision length was6cm. The mean surgical time of laparoscopic ileal cannulation was44.38min, the total length of all incisions was2cm, and the mean surgical time of corresponding open surgery was6cm. Comparison of the effects of laparoscopic and open gastrointestinal cannulation on the body’s circulatory and respiratory systems both had different degrees of inhibition. Heart rate, body temperature, blood pressure, saturation and respiratory rate decreased, and end-tidal partial pressure of carbon dioxide increased All miniature pigs could be normal tolerance, and soon returned to normal levels, but the laparoscopic surgery had less effect on the body. Comparison of the effects of laparoscopic and open gastrointestinal cannulation on the body’s inflammatory response both had impact just for a short time. Characterized by total number of WBC in whole blood raised, serum IL-6, TNF-α and IL-1β concentration increased. All of the inflammatory indicators returned to normal for a short time after surgery, but the laparoscopic group caused by the body’s inflammatory response degree is lighter than laparotomy.Through the experiment results, the following conclusions were drawn:1. The best pneumoperitoneum pressure of miniature pigs was10mmHg in condition of general anesthesia and spontaneously breathing,10mmHg is not only safe but also suitable for surgery.2. Laparoscopic gastric cannulation, laparoscopic duodenal cannulation and laparoscopic ileal cannulation were accomplished successfully; it proves the feasibility of Laparoscopic technique in the cannulation of digestive tract of the miniature pigs.3. During the operation, miniature pigs’ clinical signs, respiratory and circulatory system were monitored, after the operation, miniature pigs’mental status and wound healing were evaluated, and there were no adverse reactions, which could effectively ensure the safety of laparoscopic gastrointestinal cannulation of miniature pigs.4. Compared with the open gastrointestinal cannulation, the laparoscopic gastrointestinal cannulation of miniature pigs showed less effect on the body, little postoperative complications and inflammatory reaction, and with faster recovery. |
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