Yes, we can: reliable colonic closure with the Padlock-G clip in a survival porcine study (with video)

BackgroundSecure closure of the colonic access site is one of the most important issues for the development of natural orifice transluminal endoscopic surgery.ObjectiveTo evaluate the feasibility, reproducibility, and efficacy of a new over-the-scope clip.DesignDescriptive study, in vivo porcine colon.InterventionIn 10 female Yorkshire pigs weighing 30 to 35 kg, a 10-mm colotomy was performed by using a needle-knife and advancing the endoscope to the peritoneal cavity. Colonic closure was performed by using the Padlock-G clip (Aponos Medical, Kingston, NH) delivered with the Lock-It system (Aponos).Main Outcome MeasurementsAnimals were monitored daily for signs of peritonitis and sepsis over a period of 14 days. During necropsy, the peritoneal cavity was examined, and the colon segment containing the incision was excised for pathological study.ResultsClosure was achieved in all cases. Nine of 10 pigs survived 14 days without complications, but 1 pig was killed immediately after the procedure because of severe bleeding during the colonic incision. The median closure time was 8 minutes (range 1-30 minutes). At necropsy, adhesions were observed in 5 cases. The incision was hardly visible at the serosa side in 3 cases and was not identified in 6 cases. In 6 cases, the clip was still slightly attached to the mucosa, and it was not found in 3 cases. The pathological study revealed a complete remodeling of the colonic wall in all cases.LimitationsAnimal model, noncomparative study.ConclusionThe Padlock-G clip procedure is feasible, reproducible, effective, and easy to perform, and it provides a reliable colonic closure.