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Endoscopic suturing is superior to endoclips for closure of gastrotomy after natural orifices translumenal endoscopic surgery (NOTES): an ex vivo study

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Abstract

Background

Closure of gastrotomy remains a major barrier to clinical application of NOTES. Full-thickness closure of gastrotomy using endoscopic suturing device is presumed to be safer than that by endoclips. We evaluated the safety and feasibility of closing gastrotomy by Eagle Claw VIII, endoclips, and surgical suturing.

Methods

Fifty-one ex vivo porcine stomach models were included with 17 closures per arm. A 2-cm linear incision was created at the gastric body using scalpel externally. The time for gastrotomy closure, pneumatic bursting pressure, site of air leakage and number of suturing, or clips used were recorded. In addition, the technical difficulties of closure using Eagle Claw VIII and endoclips were assessed by a quantitative scale.

Results

All gastrotomies were successfully closed without leakage upon full gaseous distension. Closure time of Eagle Claw VIII was significantly longer than that of endoclips and surgical suturing. The median pneumatic bursting pressures were 56 (range 35–110) mmHg for Eagle Claw VIII, 19 (range 9–65) mmHg for endoclips, and 78 (range 63–110) mmHg for surgical suturing. The bursting pressures for surgical suturing and Eagle Claw VIII were significantly higher than that of endoclips (P < 0.001 for both surgical suturing vs. endoclips and Eagle Claw VIII vs. endoclips). The median scores for technical difficulties was not significantly different between endoclips and Eagle Claw VIII [9.5 (range 7–10) vs. 10 (range 8.5–10); P = 0.073].

Conclusions

The results indicated that closure of gastrotomy by Eagle Claw VIII could withstand higher endoluminal pneumatic bursting pressure than endoclips. The performance of endoscopic suturing with Eagle Claw is still difficult, and further refinement of the endoscopic suturing device is necessary for clinical application.

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Disclosure

The prototype endoscopic suturing devices (Eagle Claw VIII) were provided by R&D of Olympus Co Ltd at no cost. Liu Liu, Philip Wai Yan Chiu, Anthony Yuen Bun Teoh, Candice Chuen Hing Lam, Enders Kwok Wai Ng, and James Yun Wong Lau have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Surgery, CUHK Jockey Club Minimally Invasive Surgical Skills Center, Prince of Wales Hospital, The Chinese University of Hong Kong, 30-32 Ngan Shing Street, Shatin, NT, Hong Kong

    Liu Liu, Philip Wai Yan Chiu, Anthony Yuen Bun Teoh, Candice Chuen Hing Lam, Enders Kwok Wai Ng & James Yun Wong Lau

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  1. Liu Liu
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  2. Philip Wai Yan Chiu
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  3. Anthony Yuen Bun Teoh
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  4. Candice Chuen Hing Lam
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  6. James Yun Wong Lau
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Corresponding author

Correspondence to Philip Wai Yan Chiu.

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Liu, L., Chiu, P.W.Y., Teoh, A.Y.B. et al. Endoscopic suturing is superior to endoclips for closure of gastrotomy after natural orifices translumenal endoscopic surgery (NOTES): an ex vivo study. Surg Endosc 28, 1342–1347 (2014). https://doi.org/10.1007/s00464-013-3280-1

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  • DOI: https://doi.org/10.1007/s00464-013-3280-1

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