A novel double-endoloop technique for natural orifice transluminal endoscopic surgery gastric access site closure.
BACKGROUND
Effective and safe access site closure is critical for clinical application of natural orifice transluminal endoscopic surgery.


OBJECTIVE
The current study evaluated a simple novel technique of gastrotomy closure.


METHODS
Feasibility study with a survival animal model.


METHODS
Animal laboratory.


METHODS
Ten female domestic pigs.


METHODS
Endoscopic closure of a gastrotomy incision was evaluated in 10 pigs in a survival study. A standard double-channel endoscope was advanced into the peritoneal cavity through an incision made by a needle-knife and an 18-mm dilation balloon. After peritoneoscopy and salpingectomy, gastric closure was performed by using an endoscopic grasper and sequential application of 2 endoloops. After a follow-up period of 1 to 3 weeks, the pigs were killed for postmortem examination.


METHODS
Feasibility, efficiency, and safety of a novel closure technique.


RESULTS
Correct positioning and delivery of endoloops was achieved in all animals in a median time of 17 minutes (range 13-25 minutes). All animals survived without complications. Postmortem examination demonstrated patent full-thickness gastric closure without any evidence of infection.


CONCLUSIONS
Feasibility study with a small number of subjects in a porcine model.


CONCLUSIONS
Double endoloop technique represents a novel, simple, safe, and efficient means of gastric access site closure in natural orifice transluminal endoscopic surgery.
Hucl
Tomas
T
Department of Hepatology and Gastroenterology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
Benes
Marek
M
Kocik
Matej
M
Krak
Martin
M
Maluskova
Jana
J
Kieslichova
Eva
E
Oliverius
Martin
M
Spicak
Julius
J
D000818:Animals; D005260:Female; D005774:Gastrostomy / Q000295:instrumentation*; D020706:Laparoscopes; D010535:Laparoscopy / Q000379:methods*; D013270:Stomach / Q000601:surgery*; D013525:Surgical Instruments; D013536:Suture Techniques / Q000295:instrumentation*; D013552:Swine; D014945:Wound Healing / Q000502:physiology*