New laser soldering-based closures: a promising method in natural orifice transluminal endoscopic surgery

• Published in: Gastrointestinal endoscopy Vol. 76; no. 1; pp. 151 - 158
• Main Authors: Bogni, Serge, PhD, Ortner, Maria-Anna, MD, Vajtai, Istvan, MD, Jost, Christian, MD, Reinert, Michael, MD, Dallemagne, Bernard, MD, Frenz, Martin, PhD
• Format: Journal Article
• Language: English
• Published: Maryland heights, MO Mosby, Inc 01-07-2012; Elsevier
• Subjects: Animals; Biological and medical sciences; Digestive system. Abdomen; Endoscopy; Gastroenterology and Hepatology; Gastroenterology. Liver. Pancreas. Abdomen; Gastrostomy - methods; In Vitro Techniques; Investigative techniques, diagnostic techniques (general aspects); Lasers, Semiconductor - therapeutic use; Medical sciences; Natural Orifice Endoscopic Surgery - methods; Pilot Projects; Polyesters; Pressure; Stomach - pathology; Stomach - surgery; Sutures; Swine; Wound Closure Techniques; NOTES; natural orifice transluminal endoscopic surgery; polycaprolactone; EASIE; PCL; LTS; Erlangen Active Simulator for Interventional Endoscopy; laser tissue soldering; Natural Orifice Transluminal Endoscopic Surgery; Surgery; Laser
• ISSN: 0016-5107; 1097-6779
• DOI: 10.1016/j.gie.2012.03.006

Background Complete closure of gastrotomy is the linchpin of safe natural orifice transgastric endoscopic surgery. Objective To evaluate feasibility and efficacy of a new method of gastrotomy closure by using a sutureless laser tissue-soldering (LTS) technique in an ex vivo porcine stomach. Design In vitro experiment. Setting Experimental laboratory. Interventions Histological analysis and internal and external liquid pressure with and without hydrochloric acid exposure were determined comparing gastrotomy closure with LTS and with hand-sewn surgical sutures. Main Outcome Measurements Comparison of LTS and hand-sewn surgical gastrotomy closure. The primary outcome parameter was the internal leak pressure. Secondary parameters were the difference between internal and external leak pressures, the impact of an acid environment on the device, histological changes, and feasibility of endoscopic placement. Results The internal liquid leak pressure after LTS was almost twice as high as after hand-sewn surgical closure (416 ± 53 mm Hg vs 229 ± 99 mm Hg; P = .01). The internal leak pressure (416 ± 53 mm Hg) after LTS was higher than the external leak pressure (154 ± 46 mm Hg; P < .0001). An acidic environment did not affect leak pressure after LTS. Endoscopic LTS closure was feasible in all experiments. Histopathology revealed only slight alterations beneath the soldering plug. Limitations In vitro experiments. Conclusions Leak pressure after LTS closure of gastrotomy is higher than after hand-sewn surgical closure. LTS is a promising technique for closure of gastrotomies and iatrogenic perforations. Further experiments, in particular survival studies, are mandatory.