title: Gastrotomy creation and closure for NOTES using a gastropexy technique (with video).
abstract: BACKGROUND
  Safe and efficient gastrotomy creation and closure is pivotal for natural orifice transluminal endoscopic surgery (NOTES).
  
  
  OBJECTIVE
  To test a method of transgastric access and closure with commercially available devices.
  
  
  METHODS
  An animal survival study.
  
  
  METHODS
  University hospital.
  
  
  METHODS
  Fifteen pigs.
  
  
  METHODS
  By using a surgical suture passer, under endoscopic guidance, 3 percutaneous stay sutures were placed, in a triangular fashion, through the gastric wall. A gastrotomy was created with a dilation balloon, which was introduced over a guidewire through the gastric wall in the center of the 3 sutures. After performing a NOTES procedure, the gastrotomy was closed by tying the sutures. Necropsies were performed after 2 to 4 weeks.
  
  
  METHODS
  Success and time of gastrotomy creation and closure, and intraoperative and postoperative complications.
  
  
  RESULTS
  Gastrotomies were successfully created and closed in all the animals. The median time to create a gastrotomy was 19 minutes (range 11-85 minutes), and the median closure time was 1 minute (range 1-45 minutes). One pig died on postoperative day 1 because of peritonitis caused by a leaking gastrotomy site that extended beyond the stay sutures. There were no other gastrotomy-related complications. All gastrotomies were well healed at the necropsy.
  
  
  CONCLUSIONS
  No control group.
  
  
  CONCLUSIONS
  We evaluated a simple method by using the principles of the PEG technique combined with a gastropexy, which is familiar to the majority of endoscopists. Strict attention to the gastrotomy site is needed, because one leak was from the gastrotomy site that extended beyond the stay sutures.
authors.affiliation: Department of Surgery, School of Medicine, University of Missouri-Columbia, Columbia, Missouri 65212, USA.
authors.forename: Emanuel
authors.initials: E
authors.lastname: Sporn
authors.forename: Brent W
authors.initials: BW
authors.lastname: Miedema
authors.forename: J Andres
authors.initials: JA
authors.lastname: Astudillo
authors.forename: Sharon L
authors.initials: SL
authors.lastname: Bachman
authors.forename: Timothy S
authors.initials: TS
authors.lastname: Loy
authors.forename: J Wade
authors.initials: JW
authors.lastname: Davis
authors.forename: Robert
authors.initials: R
authors.lastname: Calaluce
authors.forename: Klaus
authors.initials: K
authors.lastname: Thaler
mesh_terms: D000818:Animals; D002404:Catheterization; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005774:Gastrostomy / Q000009:adverse effects / Q000379:methods*; D034421:Sus scrofa; D013537:Sutures