Okay. Just a word for the audience about the closure. I like to do is align the incision longitudinal incision with my shadow is seven o'clock. Please. So these are the Boston scientific resolution 360. So, with the incision. And then what you want to do is using your wheels. You want to push down to avert the edges. Close now. Open please it's not good. So the inverting of the edges is important, so that you have edge to edge opposition. So here of course this is not a very healthy dishes. Okay. Probably get closer to that one. Hi there. This is a great demonstration of clip closure, and I know you also perform closure with two types of suturing methods, what are some things you think about when you're choosing your closure method. So, standard is to me is clips. Yes. Closure. Not healthy we've done suturing. But even in this guys, we can do flipping so here you see that when I was trying to get close to the first clip. I was not happy with me because of the proposal acquisition. So I want to proximal, and that kind of reverse the edges and makes the flipping easier. So here I'm just going to continue here and then I have one extra clip to put a little bit more distantly. So you see how the clip is not really catching well. Because of the quality of the before that go ahead. We're going to force and put some clips in between. And just, you know, also for this initial decision that I did. I'm going to also have to close it because I got a little muscle. This, you know, I didn't have any muscle then I don't have to close this, but I did so I prefer closing it. But sometimes when your first time will fail, you don't touch the muscle you really don't have to close that that incident do you guys agree with Yeah, mine usually may not require closure. Although you even I prefer to close them because there's also a little bit of chance of some something bleeding from that tunnel or that attempt of the mucosal incision that you've created. So always a good idea to close it if it's possible, but it's always a good idea to close it if possible. If one cannot and if you've not really dabbled with the muscle, then you can leave it open and it's going to heal anyways, I just feel more comfortable closing it. Yeah, I think especially in these sigmoid dilated esophagus where early on, you're still might get some pooling of contents and you want good healing you don't want to, you know, you want to decrease the risk of sort of lack of closure of that mucosa, it might be compromised healing. You know, there's been a really nice description of a mucosotomy using a horizontal mucosotomy with then vertical clip closure that's been described in a video I saw by Caroline side from Brazil. And, you know, that is another method in these in these type of situations where they're, you know, very thick mucosa, maybe not so healthy dilated, and it allows a little bit early more early entry into the tunnel. So that's a that's a nice different approach. This is a demonstration you see here where the clipping bone is not difficult, especially for Syria, because it's very well. And because it's not healthy but you see it looks pretty good to me. So as I said, continue to close this second one. We are, we are done.

medical professional

clip closure techniques

surgical incisions

Boston Scientific Resolution 360 clips

alternative closure methods