Endoscopic closure of transmural bladder wall perforations.
BACKGROUND
Traditionally, intraperitoneal bladder perforations caused by trauma or iatrogenic interventions have been treated by open or laparoscopic surgery. Additionally, transvesical access to the peritoneal cavity has been reported to be feasible and useful for natural orifice translumenal endoscopic surgery (NOTES) but would be enhanced by a reliable method of closing the vesicotomy.


OBJECTIVE
To assess the feasibility and safety of an endoscopic closure method for vesical perforations using a flexible, small-diameter endoscopic suturing kit in a survival porcine model.


METHODS
This pilot study was performed at the University of Minho, Braga, Portugal, using six anesthetized female pigs.


METHODS
Closure of a full-thickness longitudinal incision in the bladder dome (up to 10 mm in four animals and up to 20 mm in two animals) with the endoscopic suturing kit using one to three absorbable stitches.


METHODS
The acute quality of sealing was immediately tested by distending the bladder with methylene-blue dye under laparoscopic control (in two animals). Without a bladder catheter, the animals were monitored daily for 2 wk, and a necropsy examination was performed to check for the signs of peritonitis, wound dehiscence, and quality of healing.


CONCLUSIONS
Endoscopic closure of bladder perforation was carried out easily and quickly in all animals. The laparoscopic view revealed no acute leak of methylene-blue dye after distension of the bladder. After recovery from anaesthesia, the pigs began to void normally, and no adverse event occurred. Postmortem examination revealed complete healing of vesical incision with no signs of infection or adhesions in the peritoneal cavity. No limitations have yet been studied clinically.


CONCLUSIONS
This study demonstrates the feasibility and the safety of endoscopic closure of vesical perforations with an endoscopic suturing kit in a survival porcine model. This study provides support for further studies using endoscopic closure of the bladder which may lead to a new era in management of bladder rupture and adoption of the transvesical port in NOTES procedures.
Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal.
Estevao
E
Lima
Carla
C
Rolanda
Luís
L
Osório
José M
JM
Pêgo
David
D
Silva
Tiago
T
Henriques-Coelho
José L
JL
Carvalho
Maria
M
Bergström
Per-Ola
PO
Park
Charles A
CA
Mosse
Paul
P
Swain
Jorge
J
Correia-Pinto
D000818:Animals; D003558:Cystoscopy / Q000379:methods*; D053715:Cystotomy; D005240:Feasibility Studies; D005260:Female; D007049:Iatrogenic Disease; D010865:Pilot Projects; D012421:Rupture / Q000601:surgery; D012422:Rupture, Spontaneous / Q000601:surgery; D013536:Suture Techniques; D013552:Swine; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000293:injuries* / Q000601:surgery*; D014950:Wounds, Penetrating / Q000601:surgery*