Feasibility of a novel single loop-and-clip gastrotomy closure ­(‘King’s closure’) after NOTES procedures in an experimental study

Authors: O. Ryska 1;  J. Martínek 2;  R. Doležel 3;  T. Filipková 4;  Š. Juhás 5;  J. Juhásová 5;  M. Zavoral 2;  I. Tučková 6;  M. Ryska 3
Authors‘ workplace: Chirurgická klinika, FN Na Bulovce, Praha2Interní klinika, 1. LF UK a ÚVN Praha3Chirurgická klinika, 2. LF UK a ÚVN Praha4Chirurgické oddělení, Nemocnice Domažlice, a. s. 5Ústav živočišné fyziologie a genetiky AV ČR, Liběchov6Oddělení patologie, ÚVN Praha 1
Published in: Gastroent Hepatol 2011; 65(4): 207-210
Category: Clinical and Experimental Gastroenterology: Original Article


The NOTES (Natural Orifice Transluminal Endoscopic Surgery) technique has recently been the subject of many experimental and several clinical trials. A safe access site closure (e.g. gastrotomy) is essential for its widespread application. The aim of our experimental study was to evaluate the feasibility and safety of a novel single loop-and-clip (‘King’s closure’) gastrotomy closure technique. A single loop-and-clip closure was performed in 24 pigs after different transgastric procedures (peritoneoscopy, liver bio­psy, ovariectomy, and cholecystectomy). A two-channel endoscope was used in all cases. Gastrotomy was performed using a needle knife followed by balloon dilatation. A single endoloop (30 mm) fixed around the gastrotomy with standard clips was used for a closure. Animals were euthanized after 30 days and autopsy was performed. The median closure time was 8 minutes and 4.5 clips were used on average. Small intra-abdominal abscesses were found in 8 (33%) animals and 15 (63%) animals had several avascular adhesions. A healed serosa-to-serosa gastrotomy closure was found in all animals confirmed by histological examination. The new single ­loop-and-clip gastrotomy closure (‘King’s closure’) is a fast, feasible and safe technique using standard accessories.

Key words:
NOTES – gastrotomy – loop-and-clip


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Paediatric gastroenterology Gastroenterology and hepatology Surgery

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