title: The Queen's closure: a novel technique for closure of endoscopic gastrotomy for natural-orifice transluminal endoscopic surgery.
abstract: OBJECTIVE
  Finding a reliable, safe, adaptable method of closing gastrotomies for natural-orifice transluminal endoscopic surgery (NOTES) procedures has been a major challenge facing this new clinical area. The Queen's NOTES Group has designed a novel endoscopic method of closing gastrotomies which involved using PolyLoop polyp ligature devices and endoscopic clips. The current study describes the technique and a pilot study of leak testing it versus hand-sewn suture closure.
  
  
  METHODS
  Ten fresh pig stomachs were used, five for each technique. A 16-mm endoscopic gastrotomy was performed on the anterior wall of each. Five stomachs were then closed using the Queen's closure technique, and five with a hand-sewn double-layer suture technique. The stomachs were then connected to a water infusion device with sensitive pressure monitoring and were filled until leakage was detected at the closure site.
  
  
  RESULTS
  The closures were all technically successful. The mean time for each gastrotomy and closure using the Queen's closure technique was 1.2 hours. The mean leak pressure for the Queen's closure was 51.8 mmHg and for the hand-sewn suture technique it was 80.8 mmHg ( P < 0.001).
  
  
  CONCLUSIONS
  The Queen's closure technique holds promise as a reliable transferable technique for closing gastrotomies. Further study is necessary to evaluate its effects in live models.
authors.affiliation: Gastrointestinal Diseases Research Unit - GI, Queen's University, Queen's University Hotel Dieu Hospital, Kingston, Ontario, Canada. lawrencehookey@yahoo.ca
authors.forename: L C
authors.initials: LC
authors.lastname: Hookey
authors.forename: V
authors.initials: V
authors.lastname: Khokhotva
authors.forename: B
authors.initials: B
authors.lastname: Bielawska
authors.forename: A
authors.initials: A
authors.lastname: Samis
authors.forename: D
authors.initials: D
authors.lastname: Jalink
authors.forename: D
authors.initials: D
authors.lastname: Hurlbut
authors.forename: D
authors.initials: D
authors.lastname: Mercer
mesh_terms: D000818:Animals; D004724:Endoscopy; D005774:Gastrostomy; D008026:Ligation; D011312:Pressure; D013270:Stomach / Q000601:surgery*; D013536:Suture Techniques; D013537:Sutures; D013552:Swine; D013718:Tensile Strength; D046509:Tissue Culture Techniques