title: Reliability of gastric access closure with the self-approximating transluminal access technique (STAT) for NOTES.
abstract: BACKGROUND
  STAT, or the self-approximating transluminal access technique, has been previously described and involves the dissection of a submucosal tunnel for peritoneal or mediastinal access from the esophagus and stomach. The objective of this study was to assess the safety and reliability of gastric access and closure in a porcine experience using STAT for natural orifice transluminal endoscopic surgery (NOTES).
  
  
  METHODS
  A review of the experience using STAT access tunnels for intraperitoneal access was performed in 39 female pigs at a university animal lab. All animals underwent a predetermined NOTES surgical procedure using a STAT transgastric access tunnel based on a specific protocol. Details of the procedure, complications, and clinical course were documented. Necropsy was performed at 2 weeks. The main outcome measurements were clinical or necropsy evidence of gastrostomy site leak or inadequate access site closure.
  
  
  RESULTS
  STAT was successful in providing safe peritoneal access in all animals. The width of the tunnel ranged from 1.5 to 5.5 cm and the length was up to 27 cm. There was no evidence of gastrostomy site leak in any animals. One animal required a single laparoscopic suture to help with tunnel closure.
  
  
  CONCLUSIONS
  STAT provides safe transgastric access and allows secure closure of the gastrotomy site.
authors.affiliation: Division of Gastroenterology, Penn State Hershey Medical Center and Penn State College of Medicine, Hershey, PA 17033, USA. amathew@psu.edu
authors.forename: Abraham
authors.initials: A
authors.lastname: Mathew
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Tomasko
authors.forename: Eric M
authors.initials: EM
authors.lastname: Pauli
authors.forename: Matthew T
authors.initials: MT
authors.lastname: Moyer
authors.forename: Jegan
authors.initials: J
authors.lastname: Gopal
authors.forename: Brooke B
authors.initials: BB
authors.lastname: Ancrile
authors.forename: Ann M
authors.initials: AM
authors.lastname: Rogers
authors.forename: Randy S
authors.initials: RS
authors.lastname: Haluck
mesh_terms: D000818:Animals; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods*; D013552:Swine