Closure of Gastrotomy After Transgastric Tubal Ligation Using the Eagle Claw VII-A Survival Experiment in a Porcine Model

Abstract

Background: The main barrier to the safe introduction of Natural Orifice Translumenal Endsocopic Surgery (NOTES) through stomach is secure closure of the gastrostomy. We tested the security of closure of gastrotomy using a prototype endoscopic suturing device-Eagle Claw VII. Method: We performed the procedures under GA in pigs weighted 50 kg. We employed double channel endoscope and inserting a long overtube to esophagus. The stomach was flushed with 1000 mls neomycin solution, and gastric puncture was performed using needle knife papillotome. This was extended with sphincterotome. The endoscope then passed via gastrotomy into the peritoneal cavity. The Fallopian tube was identified adjacent to the ovary. Bilateral tubal ligation was performed using double endoloops. The tubes were transected using needle knife. Closure of the gastrotomy was performed using the Eagle Claw VII by full thickness suturing. The sutures were tightened intracorporeally using a detachable needle tip engaged in plastic casing. The suture used is 3-O nylon. The pigs were allowed to survived for 2 weeks before euthanasia. Results: We performed transgastric bilateral tubal ligation and closure of gastrotomy in 3 pigs. The average operative time was 180 minutes. All the closures of gastrotomy were performed with 3 interrupted sutures through Eagle Claw. All the pigs tolerated diet well. Follow-up endoscopy was performed 2 weeks later and all closures were completely healed. Laparotomy was then performed and all the gastrotomy closures were confirmed to be intact without evidence of leakage. Conclusions: The gastrotomy after transgastric surgery can be safely and securely closed with Eagle Claw VII.