Endoscopic Suturing Devices

Suturing is a necessary step in any surgical operation. In flexible endoscopic surgery within and beyond the gastrointestinal tract, the task of suturing is more difficult due to limited working space and the non‐rigidity of the endoscope’s shaft making it impossible to provide a stable base for surgical manoeuvres. Besides, tactile feel is lost in the flexible endoscopic approach. Unlike in laparoscopic procedures, performing suturing and tying of knots endoscopically is a very tedious process requiring high manual dexterity and excellent hand‐eye coordination. Endoscopic suturing devices currently available for use in gastrointestinal surgery are too complex for the average endoscopist to handle, requiring much training with long learning curves. While most of the earlier endoscopic suturing devices developed for upper gastrointestinal tract uses were aimed for procedures such as fundoplication, recent developments in natural orifice translumenal endoscopic surgery (NOTES) have prompted designs suitable for transluminal surgical applications. In the absence of better visceral closure devices, most early trials in NOTES have resorted to the use of endoscopic clips or tissue anchors to reinforce closures of visceral perforations. Better, more dextrous and yet easy to handle endoscopic suturing devices are awaited.