title: Pure endoscopic full-thickness resection with peritoneoscopy and omentectomy.
abstract: OBJECTIVE
  To investigate surgical procedures for pure endoscopic full-thickness resection (EFTR) using a flexible endoscope and a prototype of a full thickness suturing device in animal experiments.
  
  
  METHODS
  Six beagles were divided into two groups: sutured with over-the-scope-clip (OTSC group, n = 3) and with a prototype of the double-arm bar suturing system (DBSS group, n = 3). The peritoneoscopy, omentectomy and EFTR procedures were performed through the transgastric route. We examined the surgical procedures required to accomplish pure EFTR and survival rates of these dogs after EFTR.
  
  
  RESULTS
  The duodenal balloon occlusion method maintained a sufficient endoscopic view during peritoneoscopy. Grooves of 10-mm wide were created around the tumor down to the third layer for treating all blood vessels and adding landmark for full-thickness resection lines. Using the muscle layer thin-cutting method, hyaluronic acid was locally injected into the muscle layer and fine incisions were made. Creating tiny perforations provided safe access to the abdominal cavity. Although it was difficult to suture the resected site safely in the OTSC group, the DBSS prototype was useful and reliable for closing there section sites with 3-0 absorbable thread. After EFTR there were no complications in the DBSS group and the dogs were in good health on POD 30, whereas in the OTSC group two dogs died due to dehiscence and gastric juice leaks. Postmortem examinations showed abscess around the suturing sites and two OTSC were detached from the suturing sites.
  
  
  CONCLUSIONS
  Pure EFTR is feasible with DBSS when systematic methods are established. The high safety of full-thickness resection suturing will permit their clinical application in the near future.
authors.forename: Hirohito
authors.initials: H
authors.lastname: Mori
authors.forename: Hideki
authors.initials: H
authors.lastname: Kobara
authors.forename: Shintaro
authors.initials: S
authors.lastname: Fujihara
authors.forename: Noriko
authors.initials: N
authors.lastname: Nishiyama
authors.forename: Maki
authors.initials: M
authors.lastname: Ayaki
authors.forename: Tatsuo
authors.initials: T
authors.lastname: Yachida
authors.forename: Keiichi
authors.initials: K
authors.lastname: Okano
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Suzuki
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Masaki
mesh_terms: D000818:Animals; D004195:Disease Models, Animal; D004285:Dogs; D004867:Equipment Design; D005240:Feasibility Studies; D020706:Laparoscopes; D010535:Laparoscopy / Q000295:instrumentation / Q000379:methods*; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods; D009852:Omentum / Q000601:surgery*; D013536:Suture Techniques / Q000009:adverse effects / Q000295:instrumentation*