Background and aims: Finding a reliable, safe, adaptable method of closing gastrotomies for natural-orifice transluminal endoscopic surgery (NOTES) procedures has been a major challenge facing this new clinical area. The Queen's NOTES Group has designed a novel endoscopic method of closing gastrotomies which involved using PolyLoop polyp ligature devices and endoscopic clips. The current study describes the technique and a pilot study of leak testing it versus hand-sewn suture closure.
Methods: Ten fresh pig stomachs were used, five for each technique. A 16-mm endoscopic gastrotomy was performed on the anterior wall of each. Five stomachs were then closed using the Queen's closure technique, and five with a hand-sewn double-layer suture technique. The stomachs were then connected to a water infusion device with sensitive pressure monitoring and were filled until leakage was detected at the closure site.
Results: The closures were all technically successful. The mean time for each gastrotomy and closure using the Queen's closure technique was 1.2 hours. The mean leak pressure for the Queen's closure was 51.8 mmHg and for the hand-sewn suture technique it was 80.8 mmHg (P < 0.001).
Conclusions: The Queen's closure technique holds promise as a reliable transferable technique for closing gastrotomies. Further study is necessary to evaluate its effects in live models.
-
1
ASGE/SAGES Working Group on Natural Orifice Translumenal Endoscopic Surgery White Paper October 2005.
Gastrointest Endosc.
2006;
63
199-203
-
2
Seaman D L, Gostout C J, de la Mora Levy J G, Knipschield M A.
Tissue anchors for transmural gut-wall apposition.
Gastrointest Endosc.
2006;
64
577-581
-
3
Dray X, Gabrielson K L, Buscaglia J M. et al .
Air and fluid leak tests after NOTES procedures: a pilot study in a live porcine model (with videos).
Gastrointest Endosc.
2008;
68
513-519
-
4
McGee M F, Marks J M, Jin J. et al .
Complete endoscopic closure of gastric defects using a full-thickness tissue plicating device.
J Gastrointest Surg.
2008;
12
38-45
-
5
McGee M F, Marks J M, Onders R P. et al .
Complete endoscopic closure of gastrotomy after natural orifice translumenal endoscopic surgery using the NDO Plicator.
Surg Endosc.
2008;
22
214-220
-
6
Meireles O R, Kantsevoy S V, Assumpcao L R. et al .
Reliable gastric closure after natural orifice translumenal endoscopic surgery (NOTES) using a novel automated flexible stapling device.
Surg Endosc.
2008;
22
1609-1613
-
7
Ryou M, Fong D G, Pai R D. et al .
Transluminal closure for NOTES: an ex vivo study comparing leak pressures of various gastrotomy and colotomy closure modalities.
Endoscopy.
2008;
40
432-436
-
8
Voermans R P, Worm A M, van Berge Henegouwen M I. et al .
In vitro comparison and evaluation of seven gastric closure modalities for natural orifice transluminal endoscopic surgery (NOTES).
Endoscopy.
2008;
40
595-601
-
9
Thele F, Zygmunt M, Glitsch A. et al .
How do gynecologists feel about transvaginal NOTES surgery?.
Endoscopy.
2008;
40
576-580
-
10
Schurr M O, Hartmann C, Ho C N. et al .
An over-the-scope clip (OTSC) system for closure of iatrogenic colon perforations: results of an experimental survival study in pigs.
Endoscopy.
2008;
40
584-588
L. C. HookeyMD
Gastrointestinal Diseases Research Unit - GI Division
Queen’s University Hotel Dieu Hospital
166 Brock Street
Kingston
Ontario K7L5G2
Canada
Fax: +1-613-5443114
Email: lawrencehookey@yahoo.ca
