Single loop-and-clips technique (king closure) for gastrotomy closure after transgastric ovariectomy: a survival experiment

Ondrej Ryska; Jan Martinek; Tereza Filipkova; Radek Dolezel; Jana Juhasova; Jan Motlik; Miroslav Zavoral; Miroslav Ryska

doi:10.5114/wiitm.2011.28870

eISSN: 2299-0054
ISSN: 1895-4588

Videosurgery and Other Miniinvasive Techniques

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abstract:

Original paper

Single loop-and-clips technique (king closure) for gastrotomy closure after transgastric ovariectomy: a survival experiment

Ondrej Ryska

,

Jan Martinek

,

Tereza Filipkova

,

Radek Dolezel

,

Jana Juhasova

,

Jan Motlik

,

Miroslav Zavoral

,

Miroslav Ryska

Videosurgery Miniinv 2012; 7 (4): 233-239

DOI: https://doi.org/10.5114/wiitm.2011.28870

Online publish date: 2012/06/25

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Introduction: A safe closure technique of transluminal access is essential for the widespread application of natural orifice transluminal endoscopic surgery (NOTES).

Aim: To evaluate the feasibility and effectiveness of a novel single loop-and-clips closure technique (KING closure).

Material and methods: An experimental survival study using female laboratory pigs was performed. A gastrotomy was performed using a standard percutaneous endoscopic gastrostomy technique. A peritoneoscopy with an ovariectomy was then performed with a double-channel endoscope, on a total of 14 pigs. Two different techniques of gastrotomy closure were analysed: a loop-and-clips closure technique (n = 7) and a standard closure using endoclips (n = 7). After a follow-up period of 30 days, the animals were euthanized for post-mortem examination.

Results: In the “loop-and-clip” closure group, the correct placement of an endoloop and clips was achieved in all animals. At necropsy, no animal showed signs of an abscess or peritonitis. Histological examination demonstrated a patent full-thickness gastric wall closure without evidence of local complications in all instances. In the “clips” group, the gastrotomy closure was assessed as probably unsafe in three animals. At necropsy 3 (42.9%) abscesses and 1 (14.3%) case of peritonitis were found.

Conclusions: A single loop-and-clips closure technique (KING closure) represents a feasible, simple and effective method of gastric incision closure. It appears to be superior to the standard endoscopic closure technique using clips.

keywords:

Single loop-and-clips technique (king closure) for gastrotomy closure after transgastric ovariectomy: a survival experiment

Ondrej Ryska , Jan Martinek , Tereza Filipkova , Radek Dolezel , Jana Juhasova , Jan Motlik , Miroslav Zavoral , Miroslav Ryska

natural orifice transluminal endoscopic surgery, gastric closure, clips, endoloop

Ondrej Ryska

,

Jan Martinek

,

Tereza Filipkova

,

Radek Dolezel

,

Jana Juhasova

,

Jan Motlik

,

Miroslav Zavoral

,

Miroslav Ryska