The OTSC clip for endoscopic organ closure in NOTES: Device and technique

The closure of the gastrotomy in Natural Orifice Transluminal Endoscopic Surgery (NOTES) is a prerequisite for transgastric endoscopic procedures in the abdominal cavity. Different techniques have been proposed and are under experimental or early clinical investigation. We describe the technique of using an over‐the‐scope‐clip system (OTSC), made of super‐elastic Nitinol and a specially designed tissue‐approximating double jaw endoscopic grasper for gastric closure. The OTSC is a clipping system mounted at the tip of the endoscope and is used for the treatment of gastrointestinal bleeding or gastrointestinal organ perforations. An enlarged version of the OTSC is now under investigation for NOTES. The closure procedure consists of two steps. First the margins of the perforation are approximated by means of an endoscopic grasper that has two mobile and one fixed jaw, thus providing two independent tissue grasping areas. Each half of this twin grasper is used to grasp one side of the perforation wound margin...