What are the elements of safe gastrotomy closure in NOTES? A systematic review.
BACKGROUND
The safe closure of the gastrotomy needs to be established before natural orifice translumenal endoscopic surgery (NOTES) can be extended to routine clinical practice. As yet no optimum closure method has been identified.


METHODS
A systematic review of the literature on gastrotomy closure modalities for NOTES up until December 2009 was undertaken. An assessment of each closure modality was determined using specified quantitative and qualitative parameters.


RESULTS
There were 46 studies included in this review describing 20 closure techniques. Some robustly designed experimental studies have now been published particularly in relation to the over-the-scope clip system.


CONCLUSIONS
Current evidence is experimental and therefore limited, but there appears to be some clarification in the direction of the innovative process in this area outlining favorable characteristics of an ideal system. Based on the studies examined in this review, a standardized assessment method is summarized for future in vivo studies, necessary prior to phase 1 trials.
Sodergren
Mikael H
MH
Department of Biosurgery and Surgical Technology, Imperial College London, London, UK. m.sodergren@imperial.ac.uk
Coomber
Ross
R
Clark
James
J
Karimyan
Vahe
V
Athanasiou
Thanos
T
Teare
Julian
J
Yang
Guang-Zhong
GZ
Darzi
Ara
A
D000818:Animals; D005774:Gastrostomy; D006801:Humans; D057605:Natural Orifice Endoscopic Surgery; D013536:Suture Techniques / Q000009:adverse effects / Q000295:instrumentation; D013537:Sutures