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. 2021 Nov 8;11:21857. doi: 10.1038/s41598-021-01396-y

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© The Author(s) 2021

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

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Endoscopic hand suturing for rectal anastomosis. (a) A porcine rectal model with anastomosis which is made with double stapling technique. (b) The rectal model having a virtual anus is fixed on a rubber roll with string. (c, d) The full layer at the proximal side of the anastomosis is sutured using a flexible needle holder (c), followed by suturing at the distal side (d). (e) In nodule suturing, a notched transparent straight hood is used. (f) A extracorporeally-created knot is delivered to the anastomotic site using the endoscope.