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Updated: Jul 4, 2026
Clinical Application of Single-Surgeon, Three-Port, Laparoscopic Resection for Colorectal Cancer with Natural Orifice Specimen Extraction
Published on: March 24, 2023
Endoscopic colotomy closure for natural orifice transluminal endoscopic surgery using a T-fastener prototype in
Emanuel Sporn1, Sharon L Bachman, Brent W Miedema
1Department of Surgery, University of Missouri-Columbia, Columbia, Missouri 65212, USA.
Background:
Safe and efficient endoscopic closure of a colotomy is essential for transcolonic peritoneal access or endoscopic full-thickness resection of the colon, if open or laparoscopic surgery is to be avoided.
Objective:
To compare the feasibility and safety of colotomy closure with the newly developed Tissue Approximation System (TAS, Ethicon Endo-Surgery, Inc.) to conventional laparoscopic suture closure.
Design:
Prospective randomized survival animal study involving 16 pigs.
Setting:
University hospital.
Interventions:
Pigs were randomized for closure of a 2- to 3-cm full-thickness colotomy with the TAS or with a conventional laparoscopic running suture.
Main Outcome Measurements:
Success of colotomy closure, time of colotomy closure, postoperative infection, and complication rates.
Results:
Colotomies were successfully closed in all animals. Median closure time (range) was 39.5 minutes (25-95 min) in the TAS group and 23 minutes (16-40 min) in the laparoscopic group (P = .0134). There were no postoperative infections or complications.
Limitations:
Closure with the TAS was performed under laparoscopic vision. There was no control group without closure of the colotomy site.
Conclusions:
Colotomies are safely closed with the TAS with comparable results to laparoscopic closure. The TAS may serve as a useful tool to close full-thickness colon defects or colotomy sites made for transluminal endoscopic procedures.