Endoscopic colotomy closure for natural orifice transluminal endoscopic surgery using a T-fastener prototype in comparison to conventional laparoscopic suture closure

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 laproscopic surgery is to be avoided. Objective: To compare the feasibility and safety of colotomy closure with the newly developed Tissue Approximation System (TAS, Ethicon-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 laproscopic 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.