Outpatient hybrid endoscopic submucosal dissection with SOUTEN for early gastric cancer,followed by endoscopic suturing of the mucosal defect:A case report

BACKGROUND Although endoscopic submucosal dissection(ESD)is becoming more common for early gastric cancer,it requires more advanced techniques and a longer treatment duration than endoscopic mucosal resection.Hybrid ESD using a multifunctional snare(SOUTEN)has been reported to be effective for colorectal lesions,as it can reduce treatment duration.Endoscopic suturing of post-ESD mucosal defects has been reported to reduce the incidence of ESD-related complications.CASE SUMMARY This study reports outpatient hybrid ESD for early gastric cancer using SOUTEN,followed by endoscopic suturing of post-ESD mucosal defects in an 86-year-old man.On referral for ESD,a 10-mm flat,depressed lesion was found on the posterior wall of the gastric antrum,the depth of which was expected to be mucosal.Given his history of delirium,we performed outpatient endoscopic treatment.The procedure used was hybrid ESD using SOUTEN to reduce the duration of treatment and endoscopic suturing of post-ESD mucosal ESD defects to reduce complications.The procedure time was 62 min and the lesion was completely resected based on histopathological examination,with no reported postoperative complications.CONCLUSION This safe and useful procedure may be especially important for outpatient endoscopic treatment.

Current applications of endoscopic suturing

Endoscopic suturing had previously been considered an experimental procedure only performed in a few centers and often by surgeons. Now, however, endoscopic suturing has evolved sufficiently to be easily implemented during procedures and is more commonly used by gastroenterologists. We have employed the Apollo Over Stitch suturing device in a variety of ways including closure of perforations, closure of full thickness defects in the gastrointestinal wall created during endoscopic full thickness resection, closure of mucosotomies during peroral endoscopic myotomy, stent fixation, fistula closure, post endoscopic submucosal dissection, endoscopic mucosal resection and Natural Orifice Transluminal Endoscopic Surgery defect closures, post-bariatric surgery gastrojejunal anastomosis revision and primary sleeve gastroplasty.

Closure techniques in exposed endoscopic full-thickness resection:Overview and future perspectives in the endoscopic suturing era

Exposed endoscopic full-thickness resection(EFTR)without laparoscopic assistance is a minimally invasive natural orifice transluminal endoscopic surgery technique that is emerging as a promising effective and safe alternative to surgery for the treatment of muscularis propria-originating gastric submucosal tumors.To date,various techniques have been used for the closure of the transmural postEFTR defect,mainly consisting in clip-and endoloop-assisted closure methods.However,the recent advent of dedicated tools capable of providing full-thickness defect suture could further improve the efficacy and safety of the exposed EFTR procedure.The aim of our review was to evaluate the efficacy and safety of the different closure methods adopted in gastric-exposed EFTR without laparoscopic assistance,also considering the recent advent of flexible endoscopic suturing.

A standardized technique for safe pancreaticojejunostomy:Pair-Watch suturing technique

AIM:To prevent pancreatic leakage after pancreaticoje-junostomy,we designed a new standardized technique that we term the "Pair-Watch suturing technique".METHODS:Before anastomosis,we imagine the faces of a pair of watches on the jejunal hole and pancreatic duct.The first stitch was put between 9 o'clock of the pancreatic side and 3 o'clock of the jejunal side,and a total of 7 stitches were put on the posterior wall,followed by the 5 stitches on the anterior wall.Using this technique,twelve stitches can be sutured on the first layer anastomosis regardless of the caliber of the pancreatic duct.In all cases the amylase activity of the drain were measured.A postoperative pancreatic fistula was diagnosed using postoperative pancreatic fistula grading.RESULTS:From March 2007 to July 2008,29 consecutive cases underwent pancreaticojejunostomy using this technique.Pathologic examination results showed pancreatic carcinoma(n=14),intraductal papillary-mucinous neoplasm(n=10),intraductal papillary-mucinous carcinoma(n=1),carcinoma of ampulla of Vater(n=1),carcinoma of extrahepatic bile duct(n=1),metastasis of renal cell carcinoma(n=1),and duodenal carcinoma(n=1).Pancreaticojejunal anastomoses using this technique were all watertight during the surgical procedure.The mean diameter of main pancreatic duct was 3.4 mm(range 2-7 mm).Three patients were recognized as having an amylase level greater than 3 times the serum amylase level,but all of them were diagnosed as grade A postoperative pancreatic fistula grading and required no treatment.None of the cases developed complications such as hemorrhage,abdominal abscess,and pulmonary infection.There was no postoperative mortality.CONCLUSION:Our technique is less complicated than other methods and very secure,providing reliable anastomosis for any size of pancreatic duct.

Affinity between Palaeozoic Blocks of Xinjiang and Their Suturing Ages

Abstract: The Kazakhstanian plate was near the Tarim, Sino-Korean and South China-Southeast Asian plates in the Middle-Late Cambrian and Late Ordovician, and approached the Siberian plate in the other periods of the Early Palaeozoic. The Ili and Toksun-Yamansu terranes had been split from the Tarim plate before the Middle Devonian and then went close to Angaraland in the late Early Permian. The Beishan area on the northeastern margin of the Tarim plate came close to Angaraland first in the early Early Permian. The suturing age between the Tarim and Kazakhstanian-Siberian plates is generally the same as that between the Turkey-Central Iran-Gangdise and South China-Southeast Asian plates. The suturing event took place in the early Early Permian, while the corresponding tectogeny occurred between the Early and Late Permian.

Looped,Broad,and Deep Buried Suturing Technique for Wound Closure

This study explores the clinical application of the circular wide and deep(looped,broad,and deep buried,LBD)suture technique for scar resection and examines its clinical effec­tiveness for scar treatment.From June 2017 to March 2019,a total of 68 patients with scars were sutured using LBD technique,and recovery was achieved 24 months postoperatively.In all 68 patients,postoperative scars were slightly evident in two cases of cervical scar,one case of leg scar,and one case of chest scar.In addition,the remaining 62 patients were completely satisfied with the outcome.The LBD suturing technique could provide sus­tained and stable tension-reducing effects postoperatively and significantly improve scar formation in patients.This method is most applicable to incisions with tension.Therefore,it should be more widely used for clinical scar treatment.

The Boundary Between Gondwana and Pacifica and the Suturing Ages of Their Allied Terranes in Southwestern China

Two terranes formed since the Late Palaeozoic can be distinguished in southwestern China. One is charac-terized by the Permo-Carboniferous ice-rafted marine gravel-bearing clastic formation and the cold-water faunaof the Gondwana facies, including the Gangmar Co, Lhasa, Sa' gya, Tengchong and Baoshan terranes and theother is marked by the Upper Palaeozoic of the Yangtze type with the Cathaysian flora and the Pacific-typefusulinids, comprising the Changning-Menglian, Shuangjiang-Lancang, Qamdo and Bayan Har terranes. TheLongmu Co-Shuanghu-Dengqen-North Lancang River-Kejie-Mengding suture zone between the two groups ofterranes is the boundary between Gondwana and Pacifica in southwestern China. On the grounds of thesedimentary formation and successive southwestward migration of the Asian nonmarine Jurassic-Cretaceousendemic bivalves, the ages of the suture and some terranes to the southwest of the suture zone are discussed.The Baoshan terrane and the Nyainrong-Sog terrane in the Lhasa composite terrane were firstly pieced togeth-er with the Asian continent in the early Early Jurassic. The northern Tibet-western Yunnan microplate, in-cluding the Gangmar Co, Lhasa and Tengchong terranes, collided with the Asian continent at the end of theEarly Cretaceous Neocomian.

Osteotendinous Suturing for Anchorage of Medial Arthrotomy in Total Knee Arthroplasty

Aim: To develop a method for closure of the arthrotomy wound and approximation of the medial periosteum at the level of tibial tuberosity after total knee arthroplasty in severe varus deformity. Method: We describe a technique of osteotendinous suturing through the tibial tuberosity for suturing of the medially elevated periosteum. Result: This is an easily reproducible technique which results in very early mobilisation and no additional complications and has several advantages over other methods of closure. Conclusion: The osteotendinous technique can be used for medial arthrotomy closure after correction of severe varus deformities and also after partial patellar tendon avulsions in total knee arthroplasty surgeries.

Treatment of Keloids in A Child with Surgery Alone:Clinical Application of the LBD Suturing Technique

Keloids are fibroproliferative disorders that can result from cutaneous injuries to the reticular dermis.Recurrence rates as high as 100%have been reported following surgical excision alone.Consequently,a variety of post-surgical techniques have been employed to prevent keloid recurrence,including the use of radiation.Although numerous studies have shown that post-excisional X-rays,electron beams,lasers,and brachytherapy can reduce the rate of keloid recurrence,numerous inconsistencies,including a wide range of definitions for keloid recurrence,render it difficult to compare the outcomes.The treatment of severe keloids in children is much more challenging,and there have been few previous reports.It is generally believed that children with keloids should be treated with nonsurgical treatment such as hormone injections and radiotherapy.For severe keloids,these methods require a long treatment period,and their efficacy is not ideal.Moreover,the side effects of the treatment can affect children’s health.If keloid scars are not effectively treated,they will often seriously affect the physical and mental health of children.The purpose of this review is to discuss case studies of children with severe keloids who were only treated with surgery and their postoperative recovery.In this case,the deep-embedded circular mattress suture technique(LBD,the looped,broad,and deep buried suturing technique)was used in the scar resection.After 18 months of follow-up,the surgical scar was evaluated using the Vancouver Scar Scale(VSS).The scar was stable and did not recur.The child was satisfied.This case shows that it is completely feasible to treat severe keloids with surgery alone,as long as the tension is reduced during the operation to prevent surgical scar hyperplasia.

A novel suturing technique for filtering glaucoma surgery:the accordion suture

AIM：To present a novel scleral flap suturing technique for filtering glaucoma surgery in order to control high postoperative intraocular pressure（IOP）.METHODS：Description of ‘the accordion suture＇ technique for mitomycin C augmented trabeculectomy.In cases of postoperative high IOP,pulling the loop of the suture helps to lift up the scleral flap by an even pressure on both edges.By means of this technique,the scleral flap opens up in an ‘‘accordion＇＇ manner,thus preventing flap obstruction and providing adequate aqueous flow.RESULTS：Our study group consisted of 8 eyes of 8 patients with neovascular glaucoma.Mean age of the subjects was 67.42±8.21 y and female/male ratio was 4/4.Mean preoperative IOP was 37±7.48 mm Hg.Mitomycin C augmented trabeculectomy was carried out on the subjects without any complications.The scleral flap closure is performed with three separate sutures;initially,our accordion suture through the center of the flap,and two releasable sutures on both corners.All the patients received removal of two side releasable sutures concomitant with pulling the accordion suture,without any complications.The average traction time was 3.5±0 wk postoperatively.The mean postoperative IOP was 11.37±2.72 mm Hg.No suture related complications were observed.CONCLUSION：This technique can be the suture of choice for filtering glaucoma surgery in experienced hands by its easy learning curve for precisely indicated patients.

Novel suturing technique,based on physical principles,achieves a breaking point double that obtained by conventional techniques

BACKGROUND Sutures have been used to repair wounds since ancient times.However,the basic suture technique has not significantly changed.In Phase I of our project,we proposed a“double diabolo”suture design,using a theoretical physical study to show that this suture receives 50%less tension than conventional sutures,and so a correspondingly greater force must be applied to break it.AIM To determine whether these theoretical levels of resistance were met by the new type of suture.METHODS An observational study was performed to compare three types of sutures,using a device that exerted force on the suture until the breaking point was reached.The tension produced by this traction was measured.The following variables were considered:Tearing stress on entry/exit points,edge separation stress,and suture break stress.The study sample consisted of 30 sutures with simple interrupted stitches(Group 1),30 with continuous stitches(Group 2),and 30 with the“double diabolo”design(Group 3).RESULTS The mean degree of force required to reach the breaking point for each of these variables(tearing,separation,and final breaking)was highest in Group 3(14.56,18.28,and 21.39 kg),followed by Group 1(7.36,10.38,and 12.81 kg)and Group 2(5.77,7.7,and 8.71 kg).These differences were statistically significant(P<0.001)in all cases.CONCLUSION The experimental results show that with the“double diabolo”suture,compared with conventional sutures,greater force must be applied to reach the breaking point(almost twice as much as in the simple interrupted suture and more than double that required for the continuous suture).If these results are confirmed in Phase III(the clinical phase)of our study,we believe the double diabolo technique should be adopted as the standard approach,especially when the suture must withstand significant tension(e.g.,laparotomy closure,thoracotomy closure,diaphragm suture,or hernial orifice closure).

Suturing Technique to Promote Graft Attachment in Challenging Cases of Descemet Stripping Endothelial Keratoplasty

Aims: To describe a technique that uses a transcorneal fixation suture for graft attachment in endothelial keratoplasty in high-risk for graft dislocation eyes. Materials and Methods: Case series included 12 eyes of 12 patients who underwent Descemet Stripping Automated Endothelial Keratoplasty (DSAEK) in the presence of high risk for graft dislocation factors. We describe a surgical technique that uses a transcorneal fixation suture to compress the donor graft onto the back surface of the recipient cornea. Outcome measures included intraoperative and postoperative complications, graft attachment and clarity and endothelial cell count at a 12 months follow-up period. Results: No intraoperative complications were noted and 11 grafts remained attached and clear with no suture related complications at a 12-month follow-up period. Partial peripheral graft detachment due to suture related graft folds, accompanied by mild corneal edema was noticed in one patient postoperatively. Reattachment and edema resolution occurred spontaneously after suture removal. The mean endothelial cell loss was 38.21% at 12 months. Conclusions: Temporary transcorneal fixation suture can be helpful in preventing graft detachment in eyes with high risk for graft dislocation.

Influence of Peritoneal Suture on the Formation of Abdominal Adhesions in Wistar Rats:Is Suturing Worthwhile?

Purpose: The purpose of the present study was to determine the effect of peritoneal closure on the formation of abdominal adhesions by verifying their degree of damage on intestinal portions and the omentum with the abdominal wall. Given the different reports found in the literature concerning peritoneal closure mostly in obstetrics and gynecology, any objective information based on statistically tested results may be of great value in the everyday surgery practice. Material and Method: This is an experimental model on which a laparotomy is performed on the free cavity of the abdominal wall in growing rats. Young Wistar rats (approximately 1 month old) were operated through a long median xipho-umbilical abdominal incision. The animals were divided in 3 groups with fifteen rats each: in Group I, only the peritoneum was left open and all the other layers of the abdominal wall were closed;the rats in Group II had their peritoneums closed with unabsorbable cord (Prolene 4-0, Ethicon?). The abdominal wall of the rats in Group III (control) was only opened up to the musculature. The peritoneum, which remained intact and closed, was carefully prodded with the grip of tweezers to avoid lesions and/or perforations in the peritoneum. Results: There were no deaths nor incisional dehiscence and/or hernias among the animals. Nine animals of Group I presented adhesions (60%), whereas there were adhesions in all the fifteen animals of Group II (100%). In Group III adhesions were found in two animals (13%). The percentage of adhesions in Group II was significantly higher than those observed in Groups I and III (p 0.0001). Adhesions were mostly formed by the abdominal omentum. It was not observed any effect of the procedure on viscera. Conclusion: The experimental model that was suggested is appropriate for the establishment and study of peritoneal adhesions. The rate of adhesions found in the Group II was significantly higher (p 0.0001) than the rate observed in the Group I and Group III, suggesting that peritoneum suture can play a important role in the adhesion processes.

5-Bromo-2'-deoxyuridine labeling:historical perspectives,factors infiuencing the detection,toxicity,and its implications in the neurogenesis

The halopyrimidine 5-bromo-2′-deoxyuridine(BrdU)is an exogenous marker of DNA synthesis.Since the introduction of monoclonal antibodies against BrdU,an increasing number of methodologies have been used for the immunodetection of this synthesized bromine-tagged base analogue into replicating DNA.BrdU labeling is widely used for identifying neuron precursors and following their fate during the embryonic,perinatal,and adult neurogenesis in a variety of vertebrate species including birds,reptiles,and mammals.Due to BrdU toxicity,its incorporation into replicating DNA presents adverse consequences on the generation,survival,and settled patterns of cells.This may lead to false results and misinterpretation in the identification of proliferative neuroblasts.In this review,I will indicate the detrimental effects of this nucleoside during the development of the central nervous system,as well as the reliability of BrdU labeling to detect proliferating neuroblasts.Moreover,it will show factors influencing BrdU immunodetection and the contribution of this nucleoside to the study of prenatal,perinatal,and adult neurogenesis.Human adult neurogenesis will also be discussed.It is my hope that this review serves as a reference for those researchers who focused on detecting cells that are in the synthetic phase of the cell cycle.

Early Triassic Volcanic Rocks in the Western Yarlung Zangbo Suture Zone:Implications for the Opening of the Neo-Tethys Ocean

In this study,zircon U-Pb dating of volcanic rocks from the Zhongba ophiolite of the Yarlung Zangbo Suture Zone(YZSZ)in southern Xizang(Tibet)yielded an age of 247±3 Ma.According to whole rock geochemical and Sr-NdPb isotopic data,the Early Triassic samples could be divided into two groups:Group 1 with P-MORB affinity,showing initial^(87)Sr/^(86)Sr ratios of 0.70253–0.70602,ε_(Nd)(t)values of 4.2–5.3,(^(206)Pb/^(204)Pb)_(t)ratios of 16.353–18.222,(^(207)Pb/^(204)Pb)_(t)ratios of 15.454–15.564,and(^(208)Pb/^(204)Pb)_(t)ratios of 35.665–38.136;Group 2 with OIB affinity,showing initial^(87)Sr/^(86)Sr ratios of 0.70249–0.70513,ε_(Nd)(t)values of 4.4–4.9,(^(206)Pb/^(204)Pb)_(t)ratios of 17.140–18.328,(^(207)Pb/^(204)Pb)_(t)ratios of 15.491–15.575,and(^(208)Pb/^(204)Pb)_(t)ratios of 36.051–38.247.Group 2 rocks formed by partial melting of the mantle source enriched by a former plume,and assimilated continental crustal material during melt ascension.The formation of Group 1 rocks corresponds to the mixing of OIB melts,with the same components as Group 2 and N-MORBs.The Zhongba Early Triassic rocks belong to the continental margin type ophiolite and formed in the continental–oceanic transition zone during the initial opening of the Neo-Tethys in southern Xizang(Tibet).

Outcomes of a non-randomised audit of single pigtail suture stents in urolithiasis management of Asian patients in Singapore

Objective:Double-J(DJ)ureteric stents are commonly placed perioperatively for semirigid or flexible ureteroscopic renal surgery.It is believed that lesser stent material within the bladder mitigates stent-related symptoms.This study aimed to evaluate the J-Fil ureteral stent,a single pigtail suture stent compared with conventional DJ stent in relation to stent symptoms in an Asian population undergoing ureterorenal intervention.Methods:Based on internal audit committee recommendation approval,the records of 50 patients retrieved,available data of 41 patients who were prospectively enrolled into two groups(Group 1[J-Fil stent group],n=21 and Group 2[DJ stent group],n=20)between August 2020 to January 2021,were analysed.Parameters compared were nature of procedure,stone location and size,ease of deployment or removal,and complications.A modified universal stent symptom questionnaire was used to assess morbidity of stent symptoms within 48 h of insertion and at removal.Results:Both groups had similar median age,distribution in male to female ratio,and stone size.The overall median universal stent symptom questionnaire score at insertion was similar for bladder pain,flank or loin pain,and quality of life between Group 1 and 2;however,at removal Group 1 fared significantly better than Group 2,especially for flank or loin pain and pain at voiding.Both groups had similar ease in insertion with no hospital readmissions.Conclusion:Our audit favoured the single pigtail suture stent in Asian ureters in mitigating stent-related issues.It showed a good safety profile with easy deployment and removal.It promises a new standard in stenting.

Double-nylon purse-string suture in closing postoperative wounds following endoscopic resection of large(≥3 cm)gastric submucosal tumors

BACKGROUND Endoscopic full-thickness resection(EFTR)of gastric submucosal tumors(SMTs)is safe and effective;however,postoperative wound management is equally important.Literature on suturing following EFTR for large(≥3 cm)SMTs is scarce and limited.AIM To evaluate the efficacy and clinical value of double-nylon purse-string suture in closing postoperative wounds following EFTR of large(≥3 cm)SMTs.METHODS We retrospectively analyzed the data of 85 patients with gastric SMTs in the fundus of the stomach or in the lesser curvature of the gastric body whose wounds were treated with double-nylon purse-string sutures after successful tumor resection at the Endoscopy Center of Renmin Hospital of Wuhan University.The operative,postoperative,and follow-up conditions of the patients were evaluated.RESULTS All tumors were completely resected using EFTR.36(42.35%)patients had tumors located in the fundus of the stomach,and 49(57.65%)had tumors located in the body of the stomach.All patients underwent suturing with double-nylon sutures after EFTR without laparoscopic assistance or further surgical treatment.Postoperative fever and stomach pain were reported in 13(15.29%)and 14(16.47%)patients,respectively.No serious adverse events occurred during the intraoperative or postoperative periods.A postoperative review of all patients revealed no residual or recurrent lesions.CONCLUSION Double-nylon purse-string sutures can be used to successfully close wounds that cannot be completely closed with a single nylon suture,especially for large(≥3 cm)EFTR wounds in SMTs.

Intermittent sliding-lock-knot suture for limbal conjunctival autograft fixation in pterygium surgery:a technique note

AIM:To report a technique used with intermittent slidinglock-knot(ISLK)fixation for limbal conjunctival autografts in pterygium surgery and compared with those of routine intermittent(RI)fixation.METHODS:Consecutive patients with primary pterygium who had undergone pterygium excision combined with limbal conjunctival autograft transplantation between March 2021 and March 2022 at our institute were retrospectively analyzed.Primary outcome measures were mean duration of surgery and suture removal,degree of conjunctival hyperemia on postoperative day 1,pain score at suture removal,postoperative symptoms at 6mo,including conjunctival hyperemia,foreign body sensation,and graft stability.RESULTS:Ninety-eight patients underwent monocular surgery and were divided into ISLK(51 eyes)and RI(47 eyes)groups according to the type of conjunctiva autograft fixation method planned.There was no significant difference in mean duration of surgery between the two groups(18.59±2.39min vs 18.15±2.20min,P=0.417);however,compared to the RI group,shorter suture removal times were observed in the ISLK group[0.58min(0.42-0.87)vs 3.00min(2.21-4.15),P<0.001].The degree of conjunctival hyperemia on postoperative day 1 was milder in the ISLK group(P<0.001).Pain scores at suture removal were lower in the ISLK group than in RI group[1(0-3)vs 2(1-4),P<0.001].Postoperative symptoms at 6mo were comparable between the groups(P=0.487),with no recurrence.CONCLUSION:ISLK is an innovative method for limbal conjunctival autograft fixation after pterygium excision.Compared to RI fixation,ISLK facilitates suture removal and reduces discomfort,with comparable surgery duration and less conjunctival hyperemia.

Clinical Epidemiology and Surgical Treatment of Spontaneous Perforations of the Terminal Ileum: A Multicentre Study in Cameroon

Background: Perforations of the terminal ileum are a frequent clinical situation and a therapeutic challenge. Surgical treatment is controversial. Several surgical modalities have been proposed and postoperative morbidity and mortality remain high. The aim of this study was to review our experience in the surgical management of perforations of the terminal ileum. Patients and methods: This is a descriptive cross-sectional study with retrospective data collection from January 1, 2017 to December 31, 2021, in five hospitals in Cameroon. Patients’ demographic, clinical presentation, surgical findings and 30-days postoperative outcomes data were collected. Results: We collected 34 files. The sex ratio was 1.4 and the average age was 20.28 years. The average consultation time was 9.1 days. Abdominal pain was present in all our patients. Peritoneal irritation was present in 46 cases (88.5%). The mean time to treatment after admission was 17.5 hours. The perforation was unique in 40 cases (76.9%) and located between 6 and 10 cm from the ileocecal valve in 29 cases (55.8%). Typhoid was the most suspected etiology intraoperatively in 38 cases (73.1%). A simple suture was performed in 18 patients (34.6%), resection with anastomosis in 11 patients (21.2%) and an ileostomy in 5 patients (9.6%). The average length of hospitalization was 21.74 days. Postoperative morbidity and mortality were 32.7% and 17.3% respectively. Conclusion: Perforations of the terminal ileum are common and affect young people. Surgical procedures are varied. Reducing consultation and care times and respecting treatment principles could improve postoperative morbidity and mortality, which remain high.

Proof of concept of a self-tightening needle-less suture using a NiTi shapememory alloy

Among surgical procedures,suturing is considered simple.However,in some situations,suturing is not easy or feasible.Here,we present proof of concept of a new self-tightening needle-less suture made of a NiTi alloy.The new device is designed to overcome two demanding steps of traditional suturing:needle introduction and manual knotting.Our novel suture is composed only of a short NiTi wire that is able to change shape by exploiting a thermoelastic phase transition.This shape change is achieved by increasing the temperature from that of the operating room(e.g.,20-22℃)to 32℃using warm water.Suturing consists of two steps:suture introduction,in which the suture is in an open configuration,and shape recovery(i.e.,closed configuration).The closed configuration is maintained at human body temperature thanks to peculiar pseudoelastic properties of the NiTi material.Finally,thermal and functional characterization verified the simplicity and effectiveness of the proposed device.