title: A Novel Method for Endoscopic Closure of Bladder Perforations During NOTES: Initial Experience from Animal Studies.
abstract: OBJECTIVE
  Translumenal access site closure remains a major challenge in natural orifice translumenal endoscopic surgery (NOTES(®); American Society for Gastrointestinal Endoscopy [Oak Brook, IL] and Society of American Gastrointestinal and Endoscopic Surgeons [Los Angeles, CA]). We assessed the feasibility and safety of using reserved threads to close the bladder perforation during NOTES and analyzed this novel technique in a live porcine model.
  
  
  METHODS
  Five female pigs were used in this study. With the animal under general anesthesia, a self-made trocar was inserted into the bladder. Under ureteroscopic guidance, the anterior bladder wall was punctured by a needle into the abdominal wall, and two reserved lines were placed. The bladder perforation was closed with the reserved lines. Procedure time and effectiveness of the closure were recorded and evaluated.
  
  
  RESULTS
  We completed a total of 5 cases of animal experiments. The first case failed because the weight and size of the animal were too large. The remaining 4 cases were successful. The procedure times were 45, 30, 25, and 25 minutes, respectively. The perforations were closed completely.
  
  
  CONCLUSIONS
  The novel method of using reserved thread to close the bladder perforation was safe and effective. Further large-scale survival studies are needed to prove its clinical potential.
authors.affiliation: Department of Urology, Changhai Hospital, The Second Military Medical University , Shanghai, China .
authors.forename: Huiqing
authors.initials: H
authors.lastname: Wang
authors.affiliation: Department of Urology, Changhai Hospital, The Second Military Medical University , Shanghai, China .
authors.forename: Chao
authors.initials: C
authors.lastname: Zhang
authors.affiliation: Department of Urology, Changhai Hospital, The Second Military Medical University , Shanghai, China .
authors.forename: Fei
authors.initials: F
authors.lastname: Guo
authors.affiliation: Department of Urology, Changhai Hospital, The Second Military Medical University , Shanghai, China .
authors.forename: Chuanliang
authors.initials: C
authors.lastname: Xu
authors.affiliation: Department of Urology, Changhai Hospital, The Second Military Medical University , Shanghai, China .
authors.forename: Linhui
authors.initials: L
authors.lastname: Wang
authors.affiliation: Department of Urology, Changhai Hospital, The Second Military Medical University , Shanghai, China .
authors.forename: Yinghao
authors.initials: Y
authors.lastname: Sun
authors.affiliation: Department of Urology, Changhai Hospital, The Second Military Medical University , Shanghai, China .
authors.forename: Bo
authors.initials: B
authors.lastname: Yang
mesh_terms: D000818:Animals; D053715:Cystotomy; D005260:Female; D057605:Natural Orifice Endoscopic Surgery / Q000295:instrumentation* / Q000379:methods; D061646:Operative Time; D013536:Suture Techniques / Q000295:instrumentation*; D013552:Swine; D001743:Urinary Bladder / Q000601:surgery*; D058106:Wound Closure Techniques / Q000295:instrumentation*