title: A novel double-endoloop technique for natural orifice transluminal endoscopic surgery gastric access site closure.
abstract: 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.
authors.affiliation: Department of Hepatology and Gastroenterology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
authors.forename: Tomas
authors.initials: T
authors.lastname: Hucl
authors.forename: Marek
authors.initials: M
authors.lastname: Benes
authors.forename: Matej
authors.initials: M
authors.lastname: Kocik
authors.forename: Martin
authors.initials: M
authors.lastname: Krak
authors.forename: Jana
authors.initials: J
authors.lastname: Maluskova
authors.forename: Eva
authors.initials: E
authors.lastname: Kieslichova
authors.forename: Martin
authors.initials: M
authors.lastname: Oliverius
authors.forename: Julius
authors.initials: J
authors.lastname: Spicak
mesh_terms: 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*