A novel method of full-thickness bladder closure with an endoscopic suturing machine: a survival porcine study

Abstract

Objective To assess the feasibility of a pure endoscopic closure method for vesical perforations using fully absorbable material. Materials and methods A pilot experimental study was performed in 8 anesthetized female pigs. Four 10mm and four 20mm endoscopic full thickness cystotomies were created. An endoscopic suturing machine (RD 180®, LSI solutions®) was deployed through the working channel of a cystoscope and used to close the incisions using absorbable stitches. Immediate assessment of the quality of the closure was obtained by distending the bladder with saline solution stained with methylene blue under laparoscopic control. After three weeks of follow up, a necropsy examination was performed to check for signs of peritonitis, wound dehiscence, and quality of healing. Results The experiment was completed in all eight animals without complications. The median procedure time was 10± 4.3 minutes. The immediate bladder distention test did not show any methylene blue leakage. The postoperative period was uneventful. The postmortem examination after 3 weeks revealed complete healing of the bladder wall incisions with no signs of infection, wound dehiscence or adhesions in the peritoneal cavity of any of the animals Conclusion This study describes a successful novel method for endoscopic closure of bladder perforations. The technique was easy, reproducible and safe. Nevertheless, further experimental investigation remains to be done before granting a clinical application of this method.