A novel double-endoloop technique for natural orifice transluminal endoscopic surgery gastric access site closure.

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.