Endoscopy 2009; 41(6): 493-497
DOI: 10.1055/s-0029-1214720
Original article

© Georg Thieme Verlag KG Stuttgart · New York

A reliable and safe gastrotomy closure technique assessed in a porcine survival model pilot study: success of the Queen’s closure

L.  C.  Hookey1 , B.  Bielawska1 , A.  Samis1 , D.  Jalink1 , R.  Ellis2 , V.  Khokhotva1 , D.  Hurlbut1 , D.  Mercer1
  • 1Gastrointestinal Diseases Research Unit, Queen’s University, Kingston, Ontario, Canada
  • 2Department of Computer and Information Science, Queen’s University, Kingston, Ontari, Canada
Further Information

Publication History

submitted 30 January 2009

accepted after revision 17 March 2009

Publication Date:
16 June 2009 (online)

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Background and study aims: The evolution of NOTES to clinical implementation has been hampered by lack of a reliable, safe, and easy-to-implement technique for closure of the opening created in accessing the peritoneum. The Queen’s closure uses a combination of endoscopic clips and loop devices to seal such defects in the stomach wall. This study aimed to assess the Queen’s closure in a porcine survival model.

Methods: Five 30-kg pigs underwent endoscopic transgastric surgery with exploration of the peritoneum. The endoscope was then withdrawn back into the stomach and the closure performed. The animals were recovered, monitored closely, and underwent endoscopy 1 week after surgery. They were then euthanized at 2 (n = 2) and 3 (n = 3) weeks after surgery with subsequent necropsy.

Results: The mean procedure time (from intubation of the esophagus to withdrawal of the endoscope) was 79 minutes (range 45 – 105 minutes) with a mean time of exploration of the peritoneum of 14 minutes (range 8 – 25 minutes). All animals recovered well with no apparent pain, distress, or signs of infection. Endoscopic examination 1 week after surgery revealed all the closures to be intact and only identifiable by a small ulcer. At necropsy, the gastrotomy site was identifiable only by minor serosal adhesions. Histological study demonstrated full-thickness closure with minimal inflammation.

Conclusions: The Queen’s closure is a reliable and safe technique that provides full-thickness gastrotomy closure without any observed complications. The technique has proven to be transferable knowledge that holds promise for clinical implementation.