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(TEM). The reason for the indisputable utility of the study lies in the fact that about 5 years ago, after over two decades of limited use of TEM due to the difficulty of the technique and to the cost of the original Richard Wolf instrumentation (Richard Wolf GmbH, Knittlingen, Germany), the scientific community began to realize that the use of this platform needed to be expanded. At the same time, Karl Storz finally invested consistently in this field, promoting the technique. The technique of transanal endoscopic operation (TEO) involves simplified and less expensive instrumentation, and demonstrates once more that 3D is not as relevant in this setting as in other types of surgery. One of the problems associated with the use of TEO remains that Karl Storz does not have a dedicated clip applier to secure the thread in the TEO set. As a result, those who still have the original TEM equipment tend to use the old Wolf clip applier with the original silver clips, while those who purchase the TEO set have to cope with this limitation of the instrumentation. A self-retained barbed suture may be an answer to this problem. However, the conventional suturing technique involves a first stitch in the middle of the defect to bring the proximal edge and the distal edge together, along the longitudinal axis of the intestine. It may seem strange to those who do not frequently practice suturing through a rigid scope,

techniques in coloproctology

To clip or not to clip? Invited comment on Wilhelm et al.: Use of self-retaining barbed suture for rectal wall closure in transanal endoscopic microsurgery