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Flexible endoscopic closure devices currently available, such as those using clips, loops clips, and snares, are designed to grasp the mucosal surface from the gastric lumen. However, they do not appear capable of closing large incisions and perforations such as those made during natural orifice translumenal endoscope surgery(NOTES), and they do not suture a large incisions and perforations that require secure closure similar to that achieved by surgical suturing. Closure with a recently reported tissue-anchoring system is more secure than that by done by clipping, but is still not yet sufficiently secure. Moreover, repair is limited to the mucosal layer, so this method is not as secure as surgical full-thickness suturing. Therefore, there is a need for a flexible endoscopic full-thickness suturing device that sutures through the full thickness of the wall. To meet this demand, we have been developing a full-thickness suturing technology for flexible endoscopic surgery. This article describes the mechanism and structure of the triple arm bar suturing device, a flexible endoscopic full-thickness suturing device developed in our laboratory.