title: Absorbable ligation loops for flexible endoscopy: a necessary tool for natural orifice transluminal endoscopic surgery.
abstract: BACKGROUND
  One of the main challenges of natural orifice transluminal endoscopic surgery (NOTES) remains the development of safe and reliable tools. In this study, we introduce the first absorbable ligatures specifically designed for NOTES.
  
  
  OBJECTIVE
  To determine the feasibility of a new absorbable ligation loop (NOTES loop) and to compare this new type of suture with the nonabsorbable loop (Endoloop) most commonly used until now.
  
  
  METHODS
  Prospective, comparative animal trial/survival animal study (observation period 21 days) with subsequent histopathological assessment (blinded observer design).
  
  
  METHODS
  Veterinarian center.
  
  
  METHODS
  This study used 12 female domestic piglets.
  
  
  METHODS
  Every pig underwent two transgastric uterine horn ligations, one with an absorbable loop and one with a nonabsorbable loop. Additional uterine horn resections on both sides were done on 6 pigs.
  
  
  METHODS
  Intervention success, loop reliability, foreign-body reaction, extent of inflammatory response (μm).
  
  
  RESULTS
  Transgastric flexible intra-abdominal ligation of the uterine horns was performed safely with both loops in all cases. During a 3-week observation period, 11 of 11 NOTES loops and 10 of 11 Endoloops were reliable. Microscopically, foreign-body reaction was minimal around both sutures (P = .303). The overall inflammatory response was larger around the Endoloops (P = .046). Uterine horn resection had an influence on the extent of inflammation.
  
  
  CONCLUSIONS
  Animal study.
  
  
  CONCLUSIONS
  Ligation was feasible with both loops. The absorbable loops were reliable during a 3-week observation period and can be recommended for use during NOTES appendectomies.
authors.affiliation: University Hospital Complex Mannheim, Central Interdisciplinary Endoscopy, Theodor-Kutzer-Ufer 1-3, Mannheim, Germany.
authors.forename: Markus B
authors.initials: MB
authors.lastname: Schoenberg
authors.forename: Philipp
authors.initials: P
authors.lastname: Ströbel
authors.forename: Daniel
authors.initials: D
authors.lastname: von Renteln
authors.forename: Axel
authors.initials: A
authors.lastname: Eickhoff
authors.forename: Georg F
authors.initials: GF
authors.lastname: Kähler
mesh_terms: D020341:Absorbable Implants; D000818:Animals; D004195:Disease Models, Animal; D019723:Endoscopes; D004867:Equipment Design; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D007044:Hysterectomy / Q000379:methods*; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods*; D018583:Pliability; D011446:Prospective Studies; D013536:Suture Techniques / Q000295:instrumentation*; D013537:Sutures; D013552:Swine