Gastrotomy creation and closure for NOTES using a gastropexy technique (with video)

Area of Science:

• Minimally Invasive Surgery
• Gastroenterology
• Surgical Innovation

Background:

• Gastrotomy creation and closure are critical for Natural Orifice Transluminal Endoscopic Surgery (NOTES).
• Existing methods require evaluation for safety and efficiency in NOTES procedures.

Purpose of the Study:

• To assess a novel transgastric access and closure technique using commercially available surgical devices.
• To evaluate the feasibility and safety of this method in an animal model.

Main Methods:

• An animal survival study was conducted involving fifteen pigs.
• Percutaneous stay sutures were placed endoscopically, followed by gastrotomy creation using a dilation balloon.
• Gastrotomy closure was achieved by tying the sutures after the NOTES procedure.

Main Results:

• Successful gastrotomy creation and closure were achieved in all subjects.
• Median time for gastrotomy creation was 19 minutes, and closure time was 1 minute.
• One instance of peritonitis occurred due to a leaking gastrotomy site, highlighting the need for meticulous closure.

Conclusions:

• The evaluated method offers a simple approach for transgastric access and closure, integrating principles of percutaneous endoscopic gastrostomy (PEG) and gastropexy.
• While effective, careful management of the gastrotomy site is essential to avoid complications like leaks.