title: What are the elements of safe gastrotomy closure in NOTES? A systematic review.
abstract: BACKGROUND
  The safe closure of the gastrotomy needs to be established before natural orifice translumenal endoscopic surgery (NOTES) can be extended to routine clinical practice. As yet no optimum closure method has been identified.
  
  
  METHODS
  A systematic review of the literature on gastrotomy closure modalities for NOTES up until December 2009 was undertaken. An assessment of each closure modality was determined using specified quantitative and qualitative parameters.
  
  
  RESULTS
  There were 46 studies included in this review describing 20 closure techniques. Some robustly designed experimental studies have now been published particularly in relation to the over-the-scope clip system.
  
  
  CONCLUSIONS
  Current evidence is experimental and therefore limited, but there appears to be some clarification in the direction of the innovative process in this area outlining favorable characteristics of an ideal system. Based on the studies examined in this review, a standardized assessment method is summarized for future in vivo studies, necessary prior to phase 1 trials.
authors.affiliation: Department of Biosurgery and Surgical Technology, Imperial College London, London, UK. m.sodergren@imperial.ac.uk
authors.forename: Mikael H
authors.initials: MH
authors.lastname: Sodergren
authors.forename: Ross
authors.initials: R
authors.lastname: Coomber
authors.forename: James
authors.initials: J
authors.lastname: Clark
authors.forename: Vahe
authors.initials: V
authors.lastname: Karimyan
authors.forename: Thanos
authors.initials: T
authors.lastname: Athanasiou
authors.forename: Julian
authors.initials: J
authors.lastname: Teare
authors.forename: Guang-Zhong
authors.initials: GZ
authors.lastname: Yang
authors.forename: Ara
authors.initials: A
authors.lastname: Darzi
mesh_terms: D000818:Animals; D005774:Gastrostomy; D006801:Humans; D057605:Natural Orifice Endoscopic Surgery; D013536:Suture Techniques / Q000009:adverse effects / Q000295:instrumentation; D013537:Sutures