New Method of Gastric Incision Closure in NOTES: Short Term Survival Study

Abstract

Background: Reliable closure of the gastric incision is one of the most important steps in NOTES procedures. Objectives: To evaluate the feasibility, efficacy and safety of a new prototype suturing device in a short term survival study in dogs after NOTES ovariectomy. Methods: Evaluation of gastric incision closure in nine dogs who underwent NOTES ovariectomy. Following trans-gastric ovariectomy, the gastric incision was closed using a prototype T-fastener device attached to a standard flexible endoscope. Four sutures were used per incision in 8 dogs (2 sutures in one dog). The animals were followed up clinically for ten days post-operatively and euthanized for post-mortem examination. The animals were closely monitored for any “leak” symptoms such as pain, tachycardia, hypertension, avoidance of food, or fever. Blood samples for surgical stress responses (IL-6, CRP), metabolic response parameters (cortisol, glucose and pre-albumin) were measured. Post-operative pain was evaluated by physiologic parameters and a standardized pain score (the Melbourne pain score). On day 10, the incisional healing as well as injury to surrounding organs were analyzed by an experienced pathologist during a necropsy examination. Setting: Academic Veterinary Hospital. Intervention: NOTES gastric incision closure using a prototype T-fastener/endoscope attachment. Results: The mean time for the gastric closure was 38 minutes. Pain threshold measurements increased postoperatively before returning to baseline within 36 hours. All animals ate their first meal within 6 hours of the procedure. At necropsy, all sites were healing as expected. There was no significant damage to surrounding organs and no evidence of peritonitis. All cultures were negative for aerobic bacteria. Conclusion: The new gastric incision closure device described seems to be effective and safe. With further improvements to the prototype we expect to reduce the closure time to less than 15 minutes. Further long-term study in live animals using this device is underway. This study was conducted in compliance with, and under the oversight of the Purdue Animal Care and Use Committee, Purdue University, West Lafayette, IN. The study is supported by a grant from NOSCAR/ASGE. T-Fastener devices provided by Cook Endoscopy.