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

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.