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  1. 1. The Appendoectomy procedure
  2. 2. 1. Overtube is pre-loaded on the colonoscope Procedural Sequence
  3. 3. Navigation Mode Procedural Sequence <ul><li>Colonoscope is maneuvered to the caecum with the Overtube in the retracted position </li></ul>
  4. 4. Procedural Sequence <ul><li>Caecum is imaged once it is reached by the colonoscope </li></ul>
  5. 5. Procedural Sequence <ul><li>Manipulator Device is introduced via the working channel over the guidewire </li></ul>
  6. 6. System in the caecum with catheter in the appendix
  7. 7. Guidewire Depth Markers Manipulator Device Procedural Sequence <ul><li>Manipulator Device is inserted into the appendix using the guidewire to cross the ostium (Balloon dilation is often required) </li></ul>
  8. 8. Procedural Sequence <ul><li>Appendix is irrigated to remove fecal & other foreign matter </li></ul>
  9. 9. Procedural Sequence <ul><li>Guidewire is replaced with stylet to perform manipulation to assess mobility of the appendix </li></ul>
  10. 10. Procedural Sequence <ul><li>Overtube & Inverter Catheter are advanced over the scope </li></ul><ul><li>Guidewire is placed through the ostium </li></ul>
  11. 11. Procedural Sequence <ul><li>Inverter Catheter is inserted </li></ul><ul><li>Overtube is advanced against caecal wall to provide counterforce </li></ul><ul><li>Sealing Sleeve is advanced over the unused vacuum holes </li></ul>
  12. 12. Procedural Sequence <ul><li>Vacuum is applied </li></ul><ul><li>Appendix inverts “From the base” as the catheter is retracted </li></ul><ul><li>Cautery is utilized to dissect the wall to aid tissue inversion </li></ul>
  13. 13. Procedural Sequence <ul><li>Inversion is completed </li></ul><ul><li>Ligature is cinched </li></ul>
  14. 14. Snare Procedural Sequence <ul><li>Polypectomy snare is advanced via the working channel to perform resection </li></ul>
  15. 15. Scissors Snare captures appendix Procedural Sequence <ul><li>Suture tail is trimmed & the polypectomy snare is used for appendix retrieval </li></ul>
  16. 16. Procedural Sequence <ul><li>Appendix is removed leaving the Overtube in place </li></ul>
  17. 17. Procedural Sequence <ul><li>Colonoscope is reinserted </li></ul><ul><li>Overtube and scope are removed under direct visualization </li></ul>