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Surgical Endoscopy

, 23:2827 | Cite as

A novel use of T-tag sutures for the safe creation and closure of the NOTES gastrotomy using a hybrid technique

  • R. C. T. AustinEmail author
  • C. A. Mosse
  • P. Swain
Dynamic Manuscript

Abstract

Transgastric Natural Orifice Translumenal Endoscopic Surgery (NOTES) procedures are presently limited by the lack of a reliable method for creating and closing the gastrotomy created during the procedure. Furthermore, due to difficulties with the NOTES technique, the majority of NOTES procedures are presently performed in a “hybrid” fashion in which some degree of laparoscopic assistance is used alongside the NOTES approach. We describe a hybrid approach with a minimal laparoscopic component allowing a very controlled gastrotomy creation and closure. This technique would also allow laparoscopic suturing through a single, small cannula.

Keywords

Natural Orifice Translumenal Endoscopic Surgery NOTES Transgastric surgery Gastrotomy 

Notes

Acknowledgments

We very gratefully acknowledge the generous loan of microlaparoscopic equipment from the Karl Storz Company in support of this work. R. Austin gratefully acknowledges receipt of a grant from the EURO-NOTES Foundation 2008.

Supplementary material

Supplementary material 1 (WMV 11929 kb)

References

  1. 1.
    Fritscher-Ravens AF, Mosse CA, Mills T, Park PO, Mukherjee D, Swain P (2002) A through-the-scope device for suturing and tissue approximation under endoscopic ultrasound control. Gastrointest Endosc 56(5):737–742CrossRefPubMedGoogle Scholar
  2. 2.
    Ikeda K, Fritscher-Ravens A, Mosse CA, Mills T, Tajiri H, Swain CP (2005) Endoscopic full-thickness resection with sutured closure in a porcine model. Gastrointest Endosc 62:122–129CrossRefPubMedGoogle Scholar
  3. 3.
    Sclabas GM, Swain P, Swanstrom LL (2006) Endoluminal methods for gastrotomy closure in natural orifice transenteric surgery (NOTES). Surg Innov 13(1):23–30CrossRefPubMedGoogle Scholar
  4. 4.
    Swain P (2007) Endoscopic suturing: now and incoming. Gastrointest Endosc Clin N Am 17(3):505–520CrossRefPubMedGoogle Scholar
  5. 5.
    Perretta S, Sereno S, Forgione A, Dallemagne B, Coumaros D, Boosfeld C, Moll C, Marescaux J (2007) A new method to close the gastrotomy by using a cardiac septal occluder: long-term survival study in a porcine model. Gastrointest Endosc 66(4):809–813CrossRefPubMedGoogle Scholar
  6. 6.
    Swanstrom LL, Whiteford M, Khajanchee Y (2008) Developing essential tools to enable transgastric surgery. Surg Endosc 22(3):600–604CrossRefPubMedGoogle Scholar
  7. 7.
    Bergström M, Swain P, Park PO (2008) Early clinical experience with a new flexible endoscopic suturing method for natural orifice transluminal endoscopic surgery and intraluminal endosurgery (with videos). Gastrointest Endosc 67(3):528–533CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  1. 1.Department of General SurgeryColchester General HospitalColchesterUK
  2. 2.Department of Medical PhysicsUniversity CollegeLondonUK
  3. 3.Department of BioSurgery and Surgical Technology, Division of Surgery, Oncology, Reproductive Biology and Anaesthetics, Faculty of MedicineImperial CollegeLondonUK

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