Back to Program | 2010 Program and Abstracts Overview | 2010 Posters

Objective: A primary challenge that remains in natural orifice translumenal endoscopic surgery (NOTES) is a consistent and safe gastric closure. Surgical technique, as well as industry taking an active role to develop an endoscopic system for gastric closure, has made transgastric surgery a clinical reality. We present a thorough literature review of gastrotomy closure technique, description of endoscopic instrumentation currently available for gastrotomy closure, and our clinical experience with transgastric surgery.Methods and Procedures: A literature review was performed using PubMed with the search criteria of: NOTES surgery, transgastric surgery, and gastrotomy closure was performed. Current products used in preclinical studies and clinical cases were reviewed in a porcine model and those with FDA approval were used in transgastric operations. The endoscopic gastrotomy closure products are described and pictures displayed. In our clinical experience we have performed 3 transgastric operations (2 appendectomies, 3 cholecystectomies) under IRB protocol. Gastric closure was obtained using the USGI Medical g-Prox. Endoscopic balloon placement in the gastrotomy was utilized for maintenance of pneumogastrum along with laparoscopic view of the closure was obtained. All of the patients were admitted to the hospital for observation per protocol. Results: Multiple techniques for gastrotomy closure are noted upon literature review. The majority of closure devices are reported in a porcine model. Six flexible closure products were evaluated; 2/6 have FDA clearance at this time. Successful gastric closure was obtained in all cases. 2 patients were discharged on POD 1 and 1 on POD 2. There was no clinical evidence of a gastric leak in any of the operations. At follow up all patients were pain free.Conclusion: Safe, reliable, and reproducible gastrotomy closure is required for transgastric access. New endoscopic technology now offers multiple options for closure and has been demonstrated successfully in clinical cases. Further technological developments and a larger clinical study is necessary to elucidate the best closure device.