Endoscopic colotomy closure for natural orifice transluminal endoscopic surgery using a T-fastener prototype in comparison to conventional laparoscopic suture closure - 23/08/11
Reprint requests: Klaus Thaler, MD, Department Surgery, One Hospital Drive, Columbia, MO 65212.Columbia, Missouri, USA
Abstract |
Background |
Safe and efficient endoscopic closure of a colotomy is essential for transcolonic peritoneal access or endoscopic full-thickness resection of the colon, if open or laparoscopic surgery is to be avoided.
Objective |
To compare the feasibility and safety of colotomy closure with the newly developed Tissue Approximation System (TAS, Ethicon Endo-Surgery, Inc.) to conventional laparoscopic suture closure.
Design |
Prospective randomized survival animal study involving 16 pigs.
Setting |
University hospital.
Interventions |
Pigs were randomized for closure of a 2- to 3-cm full-thickness colotomy with the TAS or with a conventional laparoscopic running suture.
Main Outcome Measurements |
Success of colotomy closure, time of colotomy closure, postoperative infection, and complication rates.
Results |
Colotomies were successfully closed in all animals. Median closure time (range) was 39.5 minutes (25-95 min) in the TAS group and 23 minutes (16-40 min) in the laparoscopic group (P = .0134). There were no postoperative infections or complications.
Limitations |
Closure with the TAS was performed under laparoscopic vision. There was no control group without closure of the colotomy site.
Conclusions |
Colotomies are safely closed with the TAS with comparable results to laparoscopic closure. The TAS may serve as a useful tool to close full-thickness colon defects or colotomy sites made for transluminal endoscopic procedures.
Le texte complet de cet article est disponible en PDF.Abbreviations : ACUC, AVMA, ECESD, IM, NOTES, TAS
Plan
Vol 68 - N° 4
P. 724-730 - octobre 2008 Retour au numéro
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