Arezzo Alberto, Repici Alessandro, Kirschniak Andreas, Schurr Marc O, Ho Chi-Nghia, Morino Mario
Center for Minimally Invasive Surgery, University of Torino, Torino, Italy.
Minim Invasive Ther Allied Technol. 2008;17(6):355-60. doi: 10.1080/13645700802538628.
The closure of the gastrotomy in Natural Orifice 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. These include the use of conventional endoscopic clips, newly designed clips or T-BARS in different shapes or more complicated devices such as linear endoscopic staplers and septal occluders, originally used for the treatment of cardiac septal defects. We describe here a further alternative of endoscopic organ closure in NOTES, using the OTSC, a novel type of clip attached to the tip of the endoscope. The OTSC clip as a CE-marked device is widely used clinically for various endoscopic procedures, such as the treatment of gastrointestinal bleeding and iatrogenic defects of the digestive tract, e.g. colonic perforations after endoscopic interventions. Now an enlarged version of the OTSC clip can be applied for the closure of transluminal access to the abdominal cavity and is currently being evaluated for use in NOTES. In animal tests we could demonstrate the relatively easy achievement of a full thickness closure of the gastric wall after NOTES in the experimental model. The current data base on OTSC and on other techniques proposed for organ closure after NOTES does not yet allow determining clear advantages or disadvantages of the different options. We believe the hollow organ defect closure now represents the most important issue to decode whether or not we are going to proceed with NOTES. Ongoing surviving animal labs will give us indications on how to proceed.
自然腔道内镜手术（NOTES）中胃切开术的闭合是腹腔内经胃内镜手术的前提条件。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。这些技术包括使用传统的内镜夹、新设计的夹子或不同形状的T形夹，或者更复杂的设备，如线性内镜吻合器和最初用于治疗心脏间隔缺损的间隔封堵器。我们在此描述NOTES中内镜器官闭合的另一种替代方法，即使用OTSC，一种附着在内镜尖端的新型夹子。OTSC夹作为一种带有CE标志的设备，在临床上广泛用于各种内镜手术，如治疗胃肠道出血和消化道医源性缺损，例如内镜干预后的结肠穿孔。现在，一种加大版的OTSC夹可用于闭合通向腹腔的腔道通路，目前正在评估其在NOTES中的应用。在动物实验中，我们能够证明在实验模型中NOTES术后相对容易实现胃壁全层闭合。目前关于OTSC以及NOTES术后器官闭合所提出的其他技术的数据库还无法确定不同选项的明显优缺点。我们认为，中空器官缺损的闭合现在是判断我们是否要继续开展NOTES的最重要问题。正在进行的动物存活实验将为我们提供下一步行动的指示。
