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  • Title: A novel double-endoloop technique for natural orifice transluminal endoscopic surgery gastric access site closure.
    Author: Hucl T, Benes M, Kocik M, Krak M, Maluskova J, Kieslichova E, Oliverius M, Spicak J.
    Journal: Gastrointest Endosc; 2010 Apr; 71(4):806-11. PubMed ID: 20170912.
    Abstract:
    BACKGROUND: Effective and safe access site closure is critical for clinical application of natural orifice transluminal endoscopic surgery. OBJECTIVE: The current study evaluated a simple novel technique of gastrotomy closure. DESIGN: Feasibility study with a survival animal model. SETTING: Animal laboratory. SUBJECTS: Ten female domestic pigs. INTERVENTIONS: Endoscopic closure of a gastrotomy incision was evaluated in 10 pigs in a survival study. A standard double-channel endoscope was advanced into the peritoneal cavity through an incision made by a needle-knife and an 18-mm dilation balloon. After peritoneoscopy and salpingectomy, gastric closure was performed by using an endoscopic grasper and sequential application of 2 endoloops. After a follow-up period of 1 to 3 weeks, the pigs were killed for postmortem examination. MAIN OUTCOME MEASUREMENTS: Feasibility, efficiency, and safety of a novel closure technique. RESULTS: Correct positioning and delivery of endoloops was achieved in all animals in a median time of 17 minutes (range 13-25 minutes). All animals survived without complications. Postmortem examination demonstrated patent full-thickness gastric closure without any evidence of infection. LIMITATIONS: Feasibility study with a small number of subjects in a porcine model. CONCLUSION: Double endoloop technique represents a novel, simple, safe, and efficient means of gastric access site closure in natural orifice transluminal endoscopic surgery.
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