Evidence outside the box: Minimally invasive treatment for anal fistula

Figure 1 Schematic application of the over the scope clip. A: Circumferential excision (approximately 2 cm diameter) of tissue surrounding internal opening and insertion of U-shaped sutures, positioned to allow for subsequent tensioning and guidance; B: Correct positioning of over the scope clip (OTSC) proctology applicator and subsequent advancement toward internal opening with sutures as guidance. Applicator cap should be accurately aligned to internal opening and overall orientation of applicator is parallel to axis of the anal canal; C: OTSC proctology clip application in situ.