Feasibility study for secure closure of natural orifice transluminal endoscopic surgery gastrotomies by using over-the-scope clips

Background The secure sealing of natural orifice transluminal endoscopic surgery (NOTES) approaches to the abdominal cavity is a problem that has not been solved. The feasibility of closing iatrogenic endoscopic GI-tract perforations by using a new over-the-scope clip was recently described. Objective To demonstrate the feasibility of endoscopic closure of transgastric NOTES approaches with a novel clip system. Design Acute nonsurvival animal study (porcine model; n=9). Interventions Transgastric approaches were performed by using a needle-knife and balloon dilation. After abdominopelvic exploration, the transgastric approaches were closed by using the OTSC clipping system with suction. The procedure was performed under laparoscopic visualization. Results Gastrotomy lesions could primarily be closed in 8 cases. However, the laparoscopic control indicated that the clip adaptation of the wound margins was not completely airtight under maximum insufflation of the stomach in 4 of 9 cases. Limitation Nonsurvival animal study. Conclusions Sufficient closure of transgastric NOTES approaches is feasible when using the OTSC system. When considering our clinical experience, the OTSC system was shown to be an uncomplicated and secure sealing technique in human beings.