title: Endoluminal full-thickness suture repair of gastrotomy: a survival study.
abstract: BACKGROUND
  Treatment of perforations and complications related to gastrointestinal (GI) surgery and interventional flexible endoscopy is increasingly performed endoscopically. New devices enabling secure full-thickness GI tract closures through flexible endoscopic platforms have been recently developed.
  
  
  OBJECTIVE
  To assess feasibility of endoscopic closure of a large gastrotomy using a tip-mounted flexible endoscopic suturing device.
  
  
  METHODS
  Six pigs were involved in this study. Standardized 3-cm full-thickness gastrotomies were created endoscopically in various areas of the gastric wall, in all animals, using monopolar cautery. A peritoneoscopy was performed through the gastrotomy. In four pigs, gastrotomy was repaired with an endoscopic suturing device (OverStitch™, Apollo Medical). Full-thickness suturing was started at the edges of the incision, and a figure-of-eight pattern was used. A dedicated helical tissue grasper combined with endoscopic suction was used to retract incision borders and ensure full-thickness closure. Sutures were locked using a cinching device. In two pigs, the gastrotomy was closed laparoscopically and served as a control. An air leak test was performed. On postoperative day 10 (POD 10), all pigs underwent endoscopy and laparotomy and were euthanized.
  
  
  RESULTS
  Mean endoscopic suturing time was 57.5 ± 14.15 min, and four to six sutures were delivered per incision. Laparoscopic suturing time was 8 min. All leak tests were negative. No intraoperative or postoperative complications occurred. On POD 10, all gastrotomies were healed. In one animal, thick adhesions were found surrounding the suture site but no leak was identified.
  
  
  CONCLUSIONS
  Full-thickness suturing of experimental gastrotomies using the OverStitch™ device is feasible and effective.
authors: Minimally Invasive Hybrid Surgical Institute, IHU, 1 Place de l'Hôpital, 67091, Strasbourg, France. peter.halvax@gmail.com.
authors: Peter
authors: P
authors: Halvax
authors: Minimally Invasive Hybrid Surgical Institute, IHU, 1 Place de l'Hôpital, 67091, Strasbourg, France.|Research Institute Against Cancer of the Digestive System, IRCAD, Strasbourg, France.
authors: Michele
authors: M
authors: Diana
authors: Minimally Invasive Hybrid Surgical Institute, IHU, 1 Place de l'Hôpital, 67091, Strasbourg, France.
authors: Andras
authors: A
authors: Lègner
authors: Department of Pathology, University Hospital of Strasbourg, Alsace, France.
authors: Véronique
authors: V
authors: Lindner
authors: Minimally Invasive Hybrid Surgical Institute, IHU, 1 Place de l'Hôpital, 67091, Strasbourg, France.
authors: Yu-Yin
authors: YY
authors: Liu
authors: Minimally Invasive Hybrid Surgical Institute, IHU, 1 Place de l'Hôpital, 67091, Strasbourg, France.
authors: Yoshihiro
authors: Y
authors: Nagao
authors: Minimally Invasive Hybrid Surgical Institute, IHU, 1 Place de l'Hôpital, 67091, Strasbourg, France.
authors: Sungwoo
authors: S
authors: Cho
authors: Minimally Invasive Hybrid Surgical Institute, IHU, 1 Place de l'Hôpital, 67091, Strasbourg, France.|Research Institute Against Cancer of the Digestive System, IRCAD, Strasbourg, France.
authors: Jacques
authors: J
authors: Marescaux
authors: Minimally Invasive Hybrid Surgical Institute, IHU, 1 Place de l'Hôpital, 67091, Strasbourg, France. lee.swanstrom@IHU-strasbourg.eu.
authors: Lee L
authors: LL
authors: Swanström
mesh_terms: D000818:Animals; D004867:Equipment Design; D005240:Feasibility Studies; D005773:Gastroscopy / Q000295:instrumentation / Q000379:methods; D010535:Laparoscopy; D013270:Stomach / Q000293:injuries / Q000601:surgery*; D013536:Suture Techniques / Q000295:instrumentation*; D013552:Swine
keywords: Flexible endoscopy; Full-thickness endoscopic suturing; Gastrotomy
references: Surg Endosc. 2014 Apr;28(4):1342-7
references: 24196557
references: Endoscopy. 2011;43 Suppl 2 UCTN:E319-20
references: 22020705
references: Endoscopy. 2013 Jul;45(7):532-6
references: 23801313
references: Gastroenterology. 2013 Jul;145(1):129-137.e3
references: 23567348
references: Surg Endosc. 2013 Oct;27(10):3910
references: 23708719
references: Surg Innov. 2010 Dec;17(4):318-31
references: 20829216
references: Gastrointest Endosc. 2008 Jul;68(1):11-8
references: 18577472
references: World J Gastroenterol. 2011 Jun 7;17(21):2592-6
references: 21677825
references: Gastrointest Endosc. 2009 Jun;69(7):1375-83
references: 19481658
references: Endoscopy. 2012 Jun;44(6):605-11
references: 22638781
references: Br J Surg. 2011 Nov;98(11):1503-16
references: 21877324
references: Dig Endosc. 2013 Mar;25 Suppl 1:71-8
references: 23368986
references: Surg Endosc. 2006 Feb;20(2):185
references: 16402289
references: Surg Innov. 2013 Dec;20(6):586-93
references: 23423723
references: Endoscopy. 2012 Dec;44(12):1121-6
references: 23188662
references: Gastrointest Endosc. 2012 Mar;75(3):688-90
references: 21762902
references: Arch Surg. 1974 Jun;108(6):849-53
references: 4829809