Schurr Marc O, Arezzo Alberto, Ho Chi-Nghia, Anhoeck Gunnar, Buess Gerhard, Di Lorenzo Nicola
Steinbeis University Berlin, IHCI-Institute, Tuebingen, Germany.
Minim Invasive Ther Allied Technol. 2008;17(4):262-6. doi: 10.1080/13645700802275114.
The closure of the gastrotomy in Natural Orifice Transluminal Endoscopic Surgery (NOTES) is a prerequisite for transgastric endoscopic procedures in the abdominal cavity. Different techniques have been proposed and are under experimental or early clinical investigation. We describe the technique of using an over-the-scope-clip system (OTSC), made of super-elastic Nitinol and a specially designed tissue-approximating double jaw endoscopic grasper for gastric closure. The OTSC is a clipping system mounted at the tip of the endoscope and is used for the treatment of gastrointestinal bleeding or gastrointestinal organ perforations. An enlarged version of the OTSC is now under investigation for NOTES. The closure procedure consists of two steps. First the margins of the perforation are approximated by means of an endoscopic grasper that has two mobile and one fixed jaw, thus providing two independent tissue grasping areas. Each half of this twin grasper is used to grasp one side of the perforation wound margins. Then the margins are approximated and pulled towards the OTSC cap at the tip of the scope. Then the clip is released and the access hole is closed by compression. The OTSC clip can be applied for organ closure in NOTES in experimental studies. The technique allows closing the access site from inside the gastric cavity without leaving material on the peritoneal surface of the organ.
自然腔道内镜手术（NOTES）中胃切开术的封闭是腹腔内经胃内镜手术的前提条件。人们已经提出了不同的技术，并且这些技术正处于实验或早期临床研究阶段。我们描述了一种使用内镜套扎夹系统（OTSC）的技术，该系统由超弹性镍钛合金制成，配备一个专门设计的用于胃封闭的组织贴合双钳口内镜抓持器。OTSC是一种安装在内镜尖端的夹闭系统，用于治疗胃肠道出血或胃肠道器官穿孔。一种扩大版的OTSC目前正在用于NOTES的研究中。封闭过程包括两个步骤。首先，通过一个有两个活动钳口和一个固定钳口的内镜抓持器使穿孔边缘贴合，从而提供两个独立的组织抓取区域。这个双钳抓持器的每一半用于抓取穿孔伤口边缘的一侧。然后使边缘贴合并拉向内镜尖端的OTSC帽。接着释放夹子并通过挤压封闭进入孔。在实验研究中，OTSC夹子可用于NOTES中的器官封闭。该技术能够从胃腔内封闭进入部位，而不会在器官的腹膜表面留下材料。
