Endoscopy 2022; 54(11): E668-E669
DOI: 10.1055/a-1740-3980
E-Videos

Submucosal tunneling cecetomy in a dog: is it applicable for appendectomy in human?

Xin-Yang Liu*
Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
,
Wei-Feng Chen*
Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
,
Jian-Wei Hu
Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
,
Ping-Hong Zhou
Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
,
Quan-Lin Li
Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
› Author Affiliations
Supported by: Shanghai “Rising Stars of Medical Talent” Youth Development Program (Youth Medical Talents – Specialist Program SHWJRS(2021)-99
Supported by: National Key R&D Program of China 2019YFC1315800
Supported by: National Natural Science Foundation of China http://dx.doi.org/10.13039/501100001809 82003074
Supported by: Shanghai Municipal Science and Technology Committee 19441905200
Supported by: Shanghai Municipal Education Committee 18CG07
 

We hereby present the successful application of submucosal tunneling cecetomy on a 12-kg female Beagle dog to mimic appendectomy in human. The steps were as follows ([Fig. 1], [Video 1]). Step 1: mucosal incision – the colonic cavity was intensively washed with normal saline to avoid leakage of fecal contents; the mucosa opposite the ileocecal valve was chosen for mucosal incision; a 2-cm horizontal or oblique mucosal incision was created. Step 2: submucosal tunneling – a submucosal tunnel was created until intentional perforation of the muscularis propria, about 3 cm from the appendix; the distance of 3 cm provided critical working space and better visualization of the appendix. Step 3: dissection of the appendix – the appendix was then dissected from the mesoappendix with electrocoagulation of mesentery vessels. Step 4: ligation of the appendix – the bottom of the appendix was ligated with an endoloop. Step 5: resection of the appendix – the appendix was resected using a snare; to prevent leakage, the stump was then secured with another endoloop. Step 6: retrieval and mucosal closure – the appendix was retrieved by a snare; after careful hemostasis, the mucosal incision site was closed using hemostatic clips. The procedure took 50 minutes, and the dog was sacrificed after the operation.

Zoom Image
Fig. 1 Submucosal tunneling appendectomy a Overview. b Mucosal incision. c Submucosal tunneling. d Dissection of the appendix. e Ligation of the appendix. f Resection of the appendix. g Retrieval and mucosal closure.

Video 1 Submucosal tunneling partial cecetomy in a dog.


Quality:

This novel technique combines elements from submucosal tunneling endoscopic resection (STER) [1] [2] and endoscopic intraperitoneal subserosal dissection (EISD) [3], leading to clear advantages over direct resection of the appendix from the colonic cavity [4] through a full-thickness transcolonic route. The mucosal barrier in the STER technique decreases the risk of suture failure and related complications, while the distance from perforation to the appendix leads to direct view and decreased mobility of the appendix during dissection from the mesoappendix. With accumulated experience, this technique may be further expanded for appendectomy and other natural orifice transluminal endoscopic surgeries in human.

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Competing interests

The authors declare that they have no conflict of interest.

* Co-first authors



Corresponding author

Quan-Lin Li, MD
Endoscopy Center and Endoscopy Research Institute
Zhongshan Hospital, Fudan University
180 Fenglin Road
Shanghai 200032
China   

Publication History

Article published online:
15 February 2022

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Zoom Image
Fig. 1 Submucosal tunneling appendectomy a Overview. b Mucosal incision. c Submucosal tunneling. d Dissection of the appendix. e Ligation of the appendix. f Resection of the appendix. g Retrieval and mucosal closure.