Reserved sutures for incision closure of transvesical natural orifice transluminal endoscopic surgery in pigs

Abstract

Objective To close the incision of transvesical natural orifice transluminal endoscopic surgery(NOTES) with reserved sutures in pigs,and to assess the feasibility and safety of the technique,so as to lay a foundation for future clinical application.Methods Five female pigs were inserted with self-made Trocar into the bladder under general anesthesia.Guided by ureteroscope,the needle passed the top wall of the anterior bladder and reached the abdominal wall,with two suture ends reserved for closure,one at the abdominal wall and the other in the urethra(out of Trocar).After finishing the transvesical NOTES,we pulled the suture end at the abdominal wall to the bladder and knotted outside the Trocar;then we dragged the urethra suture end to make the knot on the abdominal wall locating on the lateral wall of bladder,and then the urethral suture was knotted in Trocar and the knot was pushed to the bladder wall using a knot pushing device;finally the bladder incision was closed.The closure of the bladder incision was observed and tested with water filling method.Results The first two cases failed due to the overweight and large size of the pigs,or because the bladder incision was to close to the bladder neck,or due to the poor quality of the suture.The procedures were successful in the following 3 pigs,with the operation time periods being 45 min,30 min,and 25 min,and with satisfactory closure.Conclusion Reserved suture for incision closure of transvesical NOTES procedure is safe and feasible;the technique is easy to perform and needs no special surgery devices;and it deserves further study.