In vivo assessment of gastrotomy closure with over-the-scope clips in an experimental model for varicocelectomy (with video)

Background

Gastrotomy closure remains the major limiting factor for human translation of transgastric surgery; the over-the-scope clip (OTSC) system was proposed as a possibility for this purpose. Transgastric access is good for a pelvic approach, making varicocelectomy a possible indication for natural orifice transluminal endoscopic surgery (NOTES).

Objective

To evaluate the reliability of the OTSC system in vivo after transgastric testicular vessel ligation (varicocelectomy model).

Design

There were 3 experimental groups (5 animals in each): groups 1 and 3, gastrotomy dilation up to 18 mm, surgery was performed with a double-channel endoscope; group 2, gastrotomy dilation up to 13 mm, surgery was performed with a single-channel endoscope.

Setting

Surgical Sciences Research Domain, Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal.

Interventions

Bilateral testicular vessel ligation by transgastric access. Gastrotomy closed with the largest version of OTSC system (12 mm): a single clip in groups 1 and 2, and 2 clips in group 3. Animals were monitored for 2 weeks, killed, and submitted for necropsy.

Main Outcome Measurements

Adequacy of closure and healing after the use of the OTSC system. Statistical analysis.

Results

Vessel ligation was easily achieved in all groups. Although differences in the complication rate did not reach statistical significance (P = .099), there was a clear tendency for a better prognosis in groups 2 and 3 than group 1. In fact, only 2 animals from group 1 had complications related to incomplete gastrotomy closure.

Limitations

Small number of animals per group; nonrandomized study.

Conclusions

The OTSC system was shown to be easy and efficient for gastrotomy closure in a survival experimental model of varicocelectomy, when correctly matching the gastrotomy size with the clip size and/or number.

Abbreviations: NOTES, natural orifice transluminal endoscopic surgery, OTSC, over-the-scope clip