Yes, we can: reliable colonic closure with the Padlock-G clip in a survival porcine study (with video).
BACKGROUND
Secure closure of the colonic access site is one of the most important issues for the development of natural orifice transluminal endoscopic surgery.


OBJECTIVE
To evaluate the feasibility, reproducibility, and efficacy of a new over-the-scope clip.


METHODS
Descriptive study, in vivo porcine colon.


METHODS
In 10 female Yorkshire pigs weighing 30 to 35 kg, a 10-mm colotomy was performed by using a needle-knife and advancing the endoscope to the peritoneal cavity. Colonic closure was performed by using the Padlock-G clip (Aponos Medical, Kingston, NH) delivered with the Lock-It system (Aponos).


METHODS
Animals were monitored daily for signs of peritonitis and sepsis over a period of 14 days. During necropsy, the peritoneal cavity was examined, and the colon segment containing the incision was excised for pathological study.


RESULTS
Closure was achieved in all cases. Nine of 10 pigs survived 14 days without complications, but 1 pig was killed immediately after the procedure because of severe bleeding during the colonic incision. The median closure time was 8 minutes (range 1-30 minutes). At necropsy, adhesions were observed in 5 cases. The incision was hardly visible at the serosa side in 3 cases and was not identified in 6 cases. In 6 cases, the clip was still slightly attached to the mucosa, and it was not found in 3 cases. The pathological study revealed a complete remodeling of the colonic wall in all cases.


CONCLUSIONS
Animal model, noncomparative study.


CONCLUSIONS
The Padlock-G clip procedure is feasible, reproducible, effective, and easy to perform, and it provides a reliable colonic closure.
Guarner-Argente
Carlos
C
Endoscopy Unit, Hospital Clinic, University of Barcelona, IDIBAPS, CIBEREHD, Barcelona, Spain.
Córdova
Henry
H
Martínez-Pallí
Graciela
G
Navarro
Ricard
R
Cuatrecasas
Miriam
M
Rodríguez de Miguel
Cristina
C
Beltrán
Mireia
M
Lacy
Antonio M
AM
Ginès
Angels
A
Pellisé
Maria
M
Llach
Josep
J
Fernández-Esparrach
Glòria
G
D000818:Animals; D003106:Colon / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D023421:Models, Animal; D057605:Natural Orifice Endoscopic Surgery / Q000295:instrumentation* / Q000379:methods; D010865:Pilot Projects; D013552:Swine; D058106:Wound Closure Techniques / Q000295:instrumentation*