EUS 2008 - Endoscopic Closure of Transmural Bladder Wall Perforations: The Dawn of a New Era in Endourology

Presented by: Estevao Lima, MD, et al., at the Engineering and Urology Society (EUS) 23rd Annual Meeting - May 17, 2008 - Orlando, Florida, USA

Objectives: Traditionally, intraperitoneal bladder perforations by trauma or iatrogenic in nature have been treated by open or laparoscopic surgery. Additionally, transvesical access to the peritoneal cavity has been reported to be feasible and useful for natural orifice translumenal endoscopic surgery (NOTES) but would be enhanced by a reliable method to close the vasectomy. We assessed the feasibility and safety of endoscopic closure method of vesical perforations using a flexible, small-diameter endoscopic suturing kit in a survival porcine model.

Methods: Endoscopic closure of vesical perforations was performed in six anesthetized female pigs. Under control of cystoscopy, a full-thickness longitudinal incision (up to 10 mm in four and up to 20 mm in two animals) was created on the bladder dome. Then, the endoscopic closure of the perforation was performed with the endoscopic suturing kit, using one-to-three absorbable stitches. The acute quality of sealing was immediately tested by distending the bladder with methylene-blue dye under laparoscopic control (in two animals). Without a bladder catheter, the animals were monitored daily for 2 weeks and a necropsy examination was performed to check for the signs of peritonitis, wound dehiscence, and quality of healing.

Results: Endoscopic closure of bladder perforation was carried out easily and quickly in all animals. The laparoscopic view revealed no acute leak of methylene-blue dye after distension of the bladder. After recovery from anesthesia, the pigs began to void normally and no adverse event occurred. Postmortem examination revealed complete healing of vesical incision with no signs of infection or adhesions into the peritoneal cavity.

Conclusions: This study demonstrates the feasibility and the safety of endoscopic closure of vesical perforations with an endoscopic suturing kit in a survival porcine model. This study provides support for clinical studies using endoscopic closure of the bladder to design a new era in management of bladder rupture and transvesical port in NOTES procedures.

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