appendectomy

1. The Appendoectomy procedure

2. 1. Overtube is pre-loaded on
the colonoscope
1. Overtube is pre-loaded on
the colonoscope
Procedural Sequence

3. Navigation Mode
Procedural Sequence
2. Colonoscope is maneuvered to
the caecum with the Overtube
in the retracted position
2. Colonoscope is maneuvered to
the caecum with the Overtube
in the retracted position

4. Procedural Sequence
3. Caecum is imaged once it is
reached by the colonoscope
3. Caecum is imaged once it is
reached by the colonoscope

5. Procedural Sequence
4. Manipulator Device is
introduced via the working
channel over the guidewire
4. Manipulator Device is
introduced via the working
channel over the guidewire

6. System in the caecum with
catheter in the appendix
System in the caecum with
catheter in the appendix

7. Guidewire
Depth
Markers
Manipulator
Device
Procedural Sequence
5. Manipulator Device is inserted
into the appendix using the
guidewire to cross the ostium
(Balloon dilation is often
required)
5. Manipulator Device is inserted
into the appendix using the
guidewire to cross the ostium
(Balloon dilation is often
required)

8. Procedural Sequence
6. Appendix is irrigated to remove
fecal & other foreign matter
6. Appendix is irrigated to remove
fecal & other foreign matter

9. Procedural Sequence
7. Guidewire is replaced with stylet to
perform manipulation to assess
mobility of the appendix
7. Guidewire is replaced with stylet to
perform manipulation to assess
mobility of the appendix

10. Procedural Sequence
8. Overtube & Inverter Catheter are
advanced over the scope
9. Guidewire is placed through the ostium
8. Overtube & Inverter Catheter are
advanced over the scope
9. Guidewire is placed through the ostium

11. Procedural Sequence
10.Inverter Catheter is inserted
11.Overtube is advanced against caecal
wall to provide counterforce
12. Sealing Sleeve is advanced over
the unused vacuum holes
10.Inverter Catheter is inserted
11.Overtube is advanced against caecal
wall to provide counterforce
12. Sealing Sleeve is advanced over
the unused vacuum holes

12. Procedural Sequence
13.Vacuum is applied
14.Appendix inverts “From the base” as the
catheter is retracted
15.Cautery is utilized to dissect the wall to aid
tissue inversion
13.Vacuum is applied
14.Appendix inverts “From the base” as the
catheter is retracted
15.Cautery is utilized to dissect the wall to aid
tissue inversion

13. Procedural Sequence
16.Inversion is completed
17.Ligature is cinched17.Ligature is cinched

14. Snare
Procedural Sequence
18.Polypectomy snare is advanced via the
working channel to perform resection
18.Polypectomy snare is advanced via the
working channel to perform resection

15. Scissors
Snare captures
appendix
Procedural Sequence
19.Suture tail is trimmed & the
polypectomy snare is used for
appendix retrieval
19.Suture tail is trimmed & the
polypectomy snare is used for
appendix retrieval

16. Procedural Sequence
20.Appendix is removed leaving the
Overtube in place
20.Appendix is removed leaving the
Overtube in place

17. Procedural Sequence
21.Colonoscope is reinserted
22.Overtube and scope are removed under
direct visualization
21.Colonoscope is reinserted
22.Overtube and scope are removed under
direct visualization