Journal
VIDEOSURGERY AND OTHER MINIINVASIVE TECHNIQUES
Volume 7, Issue 4, Pages 233-239Publisher
TERMEDIA PUBLISHING HOUSE LTD
DOI: 10.5114/wiitm.2011.28870
Keywords
natural orifice transluminal endoscopic surgery; gastric closure; clips; endoloop
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Funding
- Academy of Sciences of the Czech Republic (institutional research plan) [AV0Z50450515]
- [IGA- NS9994-4]
- NATIONAL INSTITUTE OF NEUROLOGICAL DISORDERS AND STROKE [F32NS009994] Funding Source: NIH RePORTER
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Introduction: A safe closure technique of transluminal access is essential for the widespread application of natural orifice transluminal endoscopic surgery (NOTES). Aim: To evaluate the feasibility and effectiveness of a novel single loop-and-clips closure technique (KING closure). Material and methods: An experimental survival study using female laboratory pigs was performed. A gastrotomy was performed using a standard percutaneous endoscopic gastrostomy technique. A peritoneoscopy with an ovariectomy was then performed with a double-channel endoscope, on a total of 14 pigs. Two different techniques of gastrotomy closure were analysed: a loop-and-clips closure technique (n = 7) and a standard closure using endoclips (n = 7). After a follow-up period of 30 days, the animals were euthanized for post-mortem examination. Results: In the loop-and-clip closure group, the correct placement of an endoloop and clips was achieved in all animals. At necropsy, no animal showed signs of an abscess or peritonitis. Histological examination demonstrated a patent full-thickness gastric wall closure without evidence of local complications in all instances. In the clips group, the gastrotomy closure was assessed as probably unsafe in three animals. At necropsy 3 (42.9%) abscesses and 1(14.3%) case of peritonitis were found. Conclusions: A single loop-and-clips closure technique (KING closure) represents a feasible, simple and effective method of gastric incision closure. It appears to be superior to the standard endoscopic closure technique using clips.
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