Natural orifice transluminal endoscopic surgery (NOTES) is a type of minimally invasive surgery where flexible surgical tools are inserted through the body’s natural openings such as the mouth or nose, to gain access to more remote organs. This technique avoids the incisions normally required in standard laparoscopic or open surgery, and minimizes the risks of surgical site infection and scarring. There is also the potential for a reduction in the amount of sedation and analgesia required for the procedure as well as reduced postoperative pain and recovery times.

NOTES requires flexible closure techniques to replace standard laparoscopic tools such as sutures and rigid staplers.In this area, clinical work has been done to assess and compare the viability of many different closure techniques such as the over the scope clip [1], Resolution clips®, endoscopic stables, Endostich®, and a variety of t-tags [2]....

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