A novel double-endoloop technique for natural orifice transluminal endoscopic surgery gastric access site closure

• Published in: Gastrointestinal endoscopy Vol. 71; no. 4; pp. 806 - 811
• Main Authors: Hucl, Tomas, Benes, Marek, Kocik, Matej, Krak, Martin, Maluskova, Jana, Kieslichova, Eva, Oliverius, Martin, Spicak, Julius
• Format: Journal Article
• Language: English
• Published: Maryland heights, MO Mosby, Inc 01.04.2010; Elsevier
• Subjects: Animals; Biological and medical sciences; Digestive system. Abdomen; Endoscopy; Female; Gastroenterology and Hepatology; Gastroenterology. Liver. Pancreas. Abdomen; Gastrostomy - instrumentation; Investigative techniques, diagnostic techniques (general aspects); Laparoscopes; Laparoscopy - methods; Medical sciences; Stomach - surgery; Surgical Instruments; Suture Techniques - instrumentation; Swine; Wound Healing - physiology; NOTES; natural orifice transluminal endoscopic surgery; Natural Orifice Transluminal Endoscopic Surgery; Stomach; Technique; Surgery
• ISSN: 0016-5107; 1097-6779; 1097-6779
• DOI: 10.1016/j.gie.2009.10.058

Effective and safe access site closure is critical for clinical application of natural orifice transluminal endoscopic surgery. The current study evaluated a simple novel technique of gastrotomy closure. Feasibility study with a survival animal model. Animal laboratory. Ten female domestic pigs. Endoscopic closure of a gastrotomy incision was evaluated in 10 pigs in a survival study. A standard double-channel endoscope was advanced into the peritoneal cavity through an incision made by a needle-knife and an 18-mm dilation balloon. After peritoneoscopy and salpingectomy, gastric closure was performed by using an endoscopic grasper and sequential application of 2 endoloops. After a follow-up period of 1 to 3 weeks, the pigs were killed for postmortem examination. Feasibility, efficiency, and safety of a novel closure technique. Correct positioning and delivery of endoloops was achieved in all animals in a median time of 17 minutes (range 13-25 minutes). All animals survived without complications. Postmortem examination demonstrated patent full-thickness gastric closure without any evidence of infection. Feasibility study with a small number of subjects in a porcine model. Double endoloop technique represents a novel, simple, safe, and efficient means of gastric access site closure in natural orifice transluminal endoscopic surgery.