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

BackgroundEffective and safe access site closure is critical for clinical application of natural orifice transluminal endoscopic surgery.ObjectiveThe current study evaluated a simple novel technique of gastrotomy closure.DesignFeasibility study with a survival animal model.SettingAnimal laboratory.SubjectsTen female domestic pigs.InterventionsEndoscopic 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 MeasurementsFeasibility, efficiency, and safety of a novel closure technique.ResultsCorrect 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.LimitationsFeasibility study with a small number of subjects in a porcine model.ConclusionDouble endoloop technique represents a novel, simple, safe, and efficient means of gastric access site closure in natural orifice transluminal endoscopic surgery.