title: Efficacy and safety of transgastric closure in natural orifice transluminal endoscopic surgery using the OTSC system and T-bar sutures: a survival study in a porcine model.
abstract: BACKGROUND
  In natural orifice transluminal endoscopic surgery (NOTES), procedures are performed with an endoscope passed through a natural orifice. One of the most important factors that will determine the future of transgastric NOTES is obtaining a reliable closure of the access site. The aim of this study was to determine the efficacy and safety of transgastric closure using the over-the-scope clip (OTSC) system or T-bar sutures.
  
  
  METHODS
  We performed a survival study that included 15 pigs. A standardized transgastric approach to the peritoneal cavity and a peritoneoscopy were performed. The gastrotomy was closed using the OTSC system or T-bar sutures. The gastrotomy closure was tested for leaks with the methylene blue test. All animals were observed for 2 weeks before they were sacrificed and necropsy was performed. Histopathological examination of tissue samples retrieved from the access sites was performed.
  
  
  RESULTS
  There were no perioperative complications. The methylene blue test did not demonstrate any leakage of fluid. Necropsy after 2 weeks confirmed completeness of gastric closure in all animals with full-thickness healing and no spillage of gastric contents into the peritoneal cavity. No differences between the OTSC system and T-bar sutures were observed.
  
  
  CONCLUSIONS
  We observed no differences between the efficacy and safety of the OTSC system and those of T-bar sutures used in closing gastric incisions in NOTES. Both methods are safe and effective.
authors.affiliation: Department of Surgery, St. Olavs University Hospital, National Centre for Advanced Laparoscopic Surgery, Trondheim, Norway. abbassuhail99@gmail.com
authors.forename: Abbas H
authors.initials: AH
authors.lastname: Suhail
authors.forename: Ronald
authors.initials: R
authors.lastname: Mårvik
authors.forename: Jostein
authors.initials: J
authors.lastname: Halgunset
authors.forename: Esther
authors.initials: E
authors.lastname: Kuhry
mesh_terms: D000818:Animals; D004867:Equipment Design; D004869:Equipment Safety; D005260:Female; D005773:Gastroscopy / Q000295:instrumentation / Q000379:methods; D007431:Intraoperative Complications / Q000209:etiology; D057605:Natural Orifice Endoscopic Surgery / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods*; D011897:Random Allocation; D013525:Surgical Instruments; D016019:Survival Analysis; D034421:Sus scrofa; D013536:Suture Techniques / Q000009:adverse effects; D013537:Sutures; D013552:Swine