Various endoscopic suturing and tying methods have been reported, but these methods remain imperfect because knots are sometimes not tied completely and additional stitches are needed. To address this problem, we developed the “Figure 4” technique in which the knot can be easily slid to the suture point and tied by pulling suture tail— these knots will never come untied. This technique requires very simple technique and can be used in other surgical procedures such as conventional laparoscopic surgery.
