title: Feasibility study for secure closure of natural orifice transluminal endoscopic surgery gastrotomies by using over-the-scope clips.
abstract: BACKGROUND
  The secure sealing of natural orifice transluminal endoscopic surgery (NOTES) approaches to the abdominal cavity is a problem that has not been solved. The feasibility of closing iatrogenic endoscopic GI-tract perforations by using a new over-the-scope clip was recently described.
  
  
  OBJECTIVE
  To demonstrate the feasibility of endoscopic closure of transgastric NOTES approaches with a novel clip system.
  
  
  METHODS
  Acute nonsurvival animal study (porcine model; n = 9).
  
  
  METHODS
  Transgastric approaches were performed by using a needle-knife and balloon dilation. After abdominopelvic exploration, the transgastric approaches were closed by using the OTSC clipping system with suction. The procedure was performed under laparoscopic visualization.
  
  
  RESULTS
  Gastrotomy lesions could primarily be closed in 8 cases. However, the laparoscopic control indicated that the clip adaptation of the wound margins was not completely airtight under maximum insufflation of the stomach in 4 of 9 cases.
  
  
  CONCLUSIONS
  Nonsurvival animal study.
  
  
  CONCLUSIONS
  Sufficient closure of transgastric NOTES approaches is feasible when using the OTSC system. When considering our clinical experience, the OTSC system was shown to be an uncomplicated and secure sealing technique in human beings.
authors.affiliation: Clinic for General, Visceral and Transplantation Surgery, University Hospital of Tübingen, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Kratt
authors.forename: Markus
authors.initials: M
authors.lastname: Küper
authors.forename: Frank
authors.initials: F
authors.lastname: Traub
authors.forename: Chi-Nghia
authors.initials: CN
authors.lastname: Ho
authors.forename: Marc-Oliver
authors.initials: MO
authors.lastname: Schurr
authors.forename: Alfred
authors.initials: A
authors.lastname: Königsrainer
authors.forename: Frank Alexander
authors.initials: FA
authors.lastname: Granderath
authors.forename: Andreas
authors.initials: A
authors.lastname: Kirschniak
mesh_terms: D000818:Animals; D020699:Gastroscopes; D005773:Gastroscopy / Q000379:methods*; D005774:Gastrostomy / Q000379:methods*; D013525:Surgical Instruments; D034421:Sus scrofa