title: The NOTES approach to management of urinary bladder injury.
abstract: OBJECTIVE
  Inadvertent bladder injury is a potential complication of various urological and pelvic surgeries. Bladder injury can also be a complication of natural orifice transluminal endoscopic surgery (NOTES). The aim of this study was to test the feasibility  of a NOTES approach to repair bladder lacerations in a blinded porcine study.
  
  
  METHODS
  Intentional bladder lacerations were made to mimic accidental injury during NOTES in 7 pigs. In 3 animals, the site of bladder injury was identified and repaired by a blinded endoscopist. Bladder  laceration and transluminal access sites were closed with Endoclips. Leak test was performed to confirm adequate closure. Survival animals were monitored postoperatively and surgical sites were inspected for abscess, bleeding, or damage to surrounding structures at necropsy.
  
  
  RESULTS
  Complete endoscopic closure of bladder injuries was achieved in all 7 animals with a negative leak test. The site of laceration was successfully identified by the blinded endoscopist and repaired in all 3 animals in which it was attempted. Survival animals had an uneventful postoperative course  without any complications.
  
  
  CONCLUSIONS
  This blinded feasibility study shows that urinary bladder injury occurring during NOTES can be successfully managed via a NOTES approach using currently available endoscopic accessories.
authors: Division of Gastroenterology, University of Florida, Gainesville, Florida, USA.
authors: Christopher J
authors: CJ
authors: Fyock
authors: Sijo J
authors: SJ
authors: Parekattil
authors: Hany
authors: H
authors: Atalah
authors: Li-Ming
authors: LM
authors: Su
authors: Chris E
authors: CE
authors: Forsmark
authors: Mihir S
authors: MS
authors: Wagh
mesh_terms: D000818:Animals; D020776:Endoscopes, Gastrointestinal; D005240:Feasibility Studies; D005260:Female; D007431:Intraoperative Complications / Q000601:surgery*; D022125:Lacerations / Q000601:surgery*; D057605:Natural Orifice Endoscopic Surgery; D010865:Pilot Projects; D013552:Swine; D001743:Urinary Bladder / Q000293:injuries*