title: Novel method of full-thickness bladder closure with an endoscopic suturing machine: a survival study in a porcine model.
abstract: OBJECTIVE
  To assess the feasibility of a pure endoscopic closure method for vesical perforations using fully absorbable material.
  
  
  METHODS
  A pilot experimental study was performed in eight anaesthetized female pigs. Four 10-mm and four 20-mm endoscopic full thickness cystotomies were created. An endoscopic suturing machine (RD-180(®) ; LSI Solutions, Victor, NY, USA) was deployed through the working channel of a cystoscope and used to close the incisions with absorbable sutures. Immediate assessment of the quality of the closure was obtained by distending the bladder with saline solution stained with methylene blue under laparoscopic control. After 3 weeks of follow-up, a necropsy examination was performed to check for signs of peritonitis and wound dehiscence and to assess the quality of healing.
  
  
  RESULTS
  The experiment was completed in all eight pigs without complications. The median procedure time was 10 ± 4.3 min. The immediate bladder distention test did not show any methylene blue leakage. The postoperative period was uneventful. The post mortem examination after 3 weeks revealed complete healing of the bladder wall incisions with no signs of infection, wound dehiscence or adhesions in the peritoneal cavity of any of the pigs.
  
  
  CONCLUSIONS
  This study describes a successful novel method for endoscopic closure of bladder perforations. The technique was easy, reproducible and safe. Nevertheless, further experimental investigation should be carried out before clinical application of this method.
authors.affiliation: Surgical Sciences Research Domain - Life and Health Sciences Research Institute, (ICVS), University of Minho - Braga/Guimarães, Braga, Portugal; Department of Urology, Braga Hospital, Braga, Portugal.
authors.forename: Carlos
authors.initials: C
authors.lastname: Oliveira
authors.forename: Riccardo
authors.initials: R
authors.lastname: Autorino
authors.forename: Carlos
authors.initials: C
authors.lastname: Ferreira
authors.forename: Antonio
authors.initials: A
authors.lastname: Cicione
authors.forename: Rocco
authors.initials: R
authors.lastname: Damiano
authors.forename: Marco
authors.initials: M
authors.lastname: De Sio
authors.forename: Jorge
authors.initials: J
authors.lastname: Correia-Pinto
authors.forename: Estevao
authors.initials: E
authors.lastname: Lima
mesh_terms: D000818:Animals; D003558:Cystoscopy / Q000379:methods; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D010865:Pilot Projects; D016019:Survival Analysis; D013536:Suture Techniques / Q000009:adverse effects / Q000295:instrumentation*; D013552:Swine; D001743:Urinary Bladder / Q000601:surgery*; D014945:Wound Healing
keywords: NOTES; endoscopy; minimally invasive surgery; transvesical surgery