title: Peroral dual scope for natural orifice transluminal endoscopic surgery (NOTES) gastrotomy closure.
abstract: BACKGROUND
  Although transgastric intraperitoneal surgery is feasible both in experimental models and humans, secure gastrotomy closure remains challenging. As there is still no method that is simple, reliable, inexpensive, and effective, we aimed to evaluate the feasibility, efficacy, and safety of a novel endoscopic approach to this issue that intends to ensure secure healing by obtaining full thickness gastric wall apposition without requiring specialized instrumentation.
  
  
  METHODS
  Six pigs underwent general anesthesia followed by peritoneoscopy through a 12-mm gastrotomy by a double-channel endoscope. Gastrotomy closure was performed by our innovative technique. In short, this involves the insertion of a second single-channel gastroscope alongside the NOTES gastroscope. Both scopes are then worked in tandem within the stomach by separate operators using conventional endoscopic graspers and an endoclip device. The first animal was used to ascertain feasibility and standardize the technical steps, whereas the other five were survived. Postoperative follow-up then included endoscopy 1 week later and repeat endoscopy, laparoscopy, and necropsy on day 14.
  
  
  RESULTS
  All closures were immediately successful. Postoperatively, each animal demonstrated appropriate weight gain and behavioral pattern without overt postoperative complication. Necropsy showed normal healing at the gastrotomy site although there were signs of minor peritoneal irritation and infection in 2 pigs.
  
  
  CONCLUSIONS
  This transoral dual-scope clipping method of gastrotomy closure after NOTES, as well as the general concept of employing 2 separate instruments at the same time perorally, is proven technically feasible, safe, and effective in this model.
authors.affiliation: Department of Surgery, IRCAD/EITS, Strasbourg, France.
authors.forename: Misuhiro
authors.initials: M
authors.lastname: Asakuma
authors.forename: Silvana
authors.initials: S
authors.lastname: Perretta
authors.forename: Ronan A
authors.initials: RA
authors.lastname: Cahill
authors.forename: Cinthya
authors.initials: C
authors.lastname: Solano
authors.forename: Shanker
authors.initials: S
authors.lastname: Pasupathy
authors.forename: Bernard
authors.initials: B
authors.lastname: Dallemagne
authors.forename: Nobuhiko
authors.initials: N
authors.lastname: Tanigawa
authors.forename: Jacques
authors.initials: J
authors.lastname: Marescaux
mesh_terms: D034861:Abdominal Wall / Q000601:surgery*; D000818:Animals; D005240:Feasibility Studies; D020699:Gastroscopes; D005773:Gastroscopy; D005774:Gastrostomy; D020706:Laparoscopes; D010535:Laparoscopy; D013536:Suture Techniques / Q000295:instrumentation*; D013552:Swine; D014945:Wound Healing