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

Introduction: NOTES has emerged as a conceptual framework that may change the paradigm of current surgical practice. Perhaps one of the biggest hurdles to overcome is to provide a “leak proof” closure of the viscera being transgressed. Failure to achieve this aim would unequivocally result in the failure of NOTES all together. The limitations of current approaches include technical challenges or the use of inert materials that leave a permanent foreign body within or around the port of entry.. Although currently used within the field of surgery, biological scaffolds for NOTES closure have not been attempted and may overcome several of the current limitations. The current study aimed to evaluate the closure of a transgastric NOTES access using a multilayer extracellular matrix (ECM) occluder in a survival study with a canine model. Methods: Four adult female mongrel dogs were subjected to transgastric NOTES peritoneoscopy. At procedure completion, the gastrotomy was closed by deploying a two-sided ECM occluder. The construct of the occluder was such that there was ECM coverage on both sides and within the gastrotomy. . Animals were survived for 7 days (n=2) and 8 weeks (n=2). Endoscopic follow-up was performed at 48hs post-op and immediately before sacrifice. Endpoints included clinical outcome, presence of leak, peritoneal swab for culture and histology. Results: All procedures were completed uneventfully. Deployment of the device was possible in all animals and air tightness could be observed immediately after placement under laparoscopoic visualization with endoscopic insufflation. All animals had an uneventful recovery with no clinical signs of abdominal discomfort or sepsis. Endoscopy showed no air leak at 48hs. Abdominal cultures were sterile and no signs of leak were detected at 7-day or 8-week necropsy. Histology demonstrated remodeling of the scaffold with a complete gastric mucosal lining and organized loose collagen bundles. No foreign body reaction was observed at the site of injury. Discussion: The ECM occluder has been demonstrated to be safe and effective in this preclinical model. Biological scaffolds may represent a useful application for human NOTES procedures.