Illustration of the KING closure technique in endoscopic surgery.

The KING Closure: A Revolutionary Technique for Safer Gastrotomy Closures

Lena Kashyap in Health & Wellness December 2025 • 4 min read.

"Discover how the single loop-and-clips technique (KING closure) is transforming gastrotomy closure after transgastric ovariectomy, offering a survival advantage in experimental settings."

Natural Orifice Transluminal Endoscopic Surgery (NOTES) is changing surgery, allowing surgeons to operate through natural openings in the body. But to really take off, NOTES needs reliable ways to close up the surgical sites afterward. A weak closure can lead to major problems, making a strong closure technique a must-have.

One promising solution is the 'KING closure,' a technique that uses a single loop and clips to close gastrotomies—surgical openings in the stomach. Researchers have been putting it to the test, comparing it against standard closure methods to see if it really holds up.

This article dives into a study that explores how well the KING closure works in pigs undergoing transgastric ovariectomies (ovary removal through the stomach). We'll look at how it's done, what the results were, and what it could mean for the future of NOTES and other procedures.

KING Closure: A Step-by-Step Look at the Technique

Illustration of the KING closure technique in endoscopic surgery.

The KING closure method was tested on pigs and works by first making a small incision in the stomach using a percutaneous endoscopic gastrostomy (PEG) technique. After this, surgeons performed a peritoneoscopy to remove the ovaries with a double-channel endoscope. The critical part comes next: closing the stomach incision.

In the experimental group, the KING closure was performed using these steps:

An endoloop is positioned around the gastrotomy site.
Clips are strategically placed to secure the loop.
A grasper pulls the incision edges together inside the loop.
The loop is tightened, cinching the edges closed.

Researchers then compared this method to a standard closure technique that only used clips. The animals were monitored for 30 days, and then a post-mortem examination was performed to assess the safety and effectiveness of each closure method. The results speak volumes about the potential of the KING closure.

The Future of Gastrotomy Closure: Safer Procedures on the Horizon

The single loop-and-clips technique (KING closure) offers a promising alternative to traditional gastrotomy closure methods. The study showed that the KING closure had fewer complications, like abscesses and peritonitis, compared to using clips alone.

While this research is a significant step forward, it's important to remember that it was performed on pigs. More studies are needed to confirm if the KING closure is as safe and effective in humans. But, the initial results are encouraging, suggesting that this technique could lead to fewer complications and better outcomes for patients undergoing NOTES procedures.

As NOTES and other minimally invasive surgeries continue to evolve, innovations like the KING closure will be crucial for making these procedures safer and more accessible.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.5114/wiitm.2011.28870, Alternate LINK

Title: Single Loop-And-Clips Technique (King Closure) For Gastrotomy Closure After Transgastric Ovariectomy: A Survival Experiment

Subject: Urology

Journal: Videosurgery and Other Miniinvasive Techniques

Publisher: Termedia Sp. z.o.o.

Authors: Ondrej Ryska, Jan Martinek, Tereza Filipkova, Radek Dolezel, Jana Juhasova, Jan Motlik, Miroslav Zavoral, Miroslav Ryska

Published: 2012-01-01

Everything You Need To Know

What exactly is the KING closure technique?

The KING closure is a method that uses a single loop and clips to close gastrotomies. It's a technique designed to make the process of closing surgical openings in the stomach safer and more effective, particularly in procedures like transgastric ovariectomy. This method is important because it addresses a critical need in Natural Orifice Transluminal Endoscopic Surgery (NOTES): reliable closure of surgical sites to prevent complications.

How is the KING closure performed in a transgastric ovariectomy?

In the context of transgastric ovariectomy in pigs, the KING closure method involves these steps: First, a small incision is made in the stomach using a percutaneous endoscopic gastrostomy (PEG) technique. Then, an endoloop is positioned around the gastrotomy site, and clips are strategically placed to secure the loop. A grasper pulls the incision edges together inside the loop, and finally, the loop is tightened, cinching the edges closed. This contrasts with traditional methods, which may only use clips.

Why is the KING closure important in this context?

The significance of the KING closure lies in its potential to improve outcomes in Natural Orifice Transluminal Endoscopic Surgery (NOTES). The study showed that the KING closure had fewer complications, like abscesses and peritonitis, compared to using clips alone, offering a survival advantage in experimental settings. By providing a stronger and more reliable closure, it minimizes the risk of leakage and infection, key challenges in NOTES.

What are the implications of the KING closure?

The implications of the KING closure are far-reaching for the future of surgery, especially in procedures like Natural Orifice Transluminal Endoscopic Surgery (NOTES). By demonstrating fewer complications and improved outcomes in experimental settings, it suggests that the KING closure could lead to safer procedures. As surgeons become more comfortable with new techniques like the KING closure, the more NOTES can become more common.

What are the advantages of using the KING closure compared to other methods?

The potential benefit of the KING closure over other methods, such as using clips alone, is improved patient outcomes. The study showed that the KING closure resulted in fewer complications like abscesses and peritonitis. This survival advantage is significant because it demonstrates the clinical importance of effective gastrotomy closure in minimizing post-operative risks and promoting faster recovery times. The study also revealed the KING closure to be more effective than the standard methods.