Transcolonic endoscopic appendectomy using a novel integrated snare-knife device - a case report

Sep 30, 2026

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A 57-year-old woman with an incidental 5 mm appendiceal orifice protrusion underwent transcolonic endoscopic appendectomy using a novel integrated snare-knife device. Under non-intubated anesthesia and left lateral positioning, the team used integrated needle-mode submucosal injection, circumferential incision, and full-thickness dissection with intermittent electrocoagulation. Minimal purulent material was encountered at peritoneal entry. The appendix was resected and retrieved with the integrated snare; the enterotomy was closed using a rubber-band traction system derived from a glove and endoscopic suturing, with drainage placement under direct visualization. Resection was completed in 30 minutes with total procedural time of 60 minutes, pathology showed chronic inflammation with abscess, and follow-up colonoscopy at 4 months confirmed good healing.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages2

Reading Time5 min

AccessFree to download

Case Presentation and Procedure

Operative Technique and Outcomes

Pathology and Follow-up

Contributors, Funding, and Disclosures

Article published online: 2026-01-08 Transcolonic endoscopic appendectomy using a novel integrated snare-knife device: a case report ▶Fig. 1 Transcolonic endoscopic appendectomy using the snare probe throughout the procedure. a Protruding lesions adjacent to the appendix. b Mucosal incision. c Submucosal injection. d Coagulation for hemostasis. e Conversion to the snare for appendiceal resection. f Application of the traction clip for wound closure. g Appendix removed by snare mode. h The resected specimen. Video 1 Transcolonic endoscopic appendectomy using a novel integrated snare-knife device. A 57-year-old woman presented with an incidental 5mm protrusion at the appendiceal orifice, identified during a routine examination. The asymptomatic patient ▶Fig.2 Colonoscopy images at a 4-month postoperative follow-up. had no notable medical history. Under non-intubated anesthesia with the patient positioned in the left lateral decubitus position, the procedure was initiated with a submucosal injection utilizing the integrated needle mode. Furthermore, acircumferential incision was created followed by full-thickness dissection with intermittent electrocoagulation. Meanwhile, the minimal purulent material was encountered during peritoneal entry. The appendiceal mesentery was systematically divided utilizing the knife function, followed by complete resection of the appendix and specimen retrieval with the integrated snare. Post-resection, the enterotomy was closed utilizing a glovederived rubber band traction system combined with endoscopic suturing. Additionally, a drainage catheter was deployed under direct visualization ( ▶ Fig.1) . Within 30 minutes, appendiceal resection was completed and the total procedural duration was only 60 minutes ( ▶Video 1) . Histopathological analysis confirmed chronic inflammation of the appendix with associated abscess formation. The patient experienced no postoperative discomfort. A follow-up colonoscopy performed 4 months later demonstrated good healing of the surgical incision ( ▶ Fig.2) . Huang Tingxuan et al. Transcolonic endoscopic appendectomy… Endoscopy 2026; 58: E19–E20 | © 2026. The Author(s) . E19 This represents the first documented utilization of a multifunctional snare probe combining the electrosurgical knife, snare, and injection needle capabilities in NOTES appendectomy [1–3] . Endoscopy_UCTN_Code_TTT_ 1AT_ 2AZ Contributors ʼ Statement Tingxuan Huang: Data curation, Funding acquisition, Investigation, Writing – original draft. Fenglin Chen: Conceptualization, Project administration, Writing – review & editing. Xin-Yang Liu: Methodology, Project administration, Supervision, Validation. Xiaoxiong Guo: Data curation, Investigation, Resources. Ping-Hong Zhou: Investigation, Methodology, Project administration, Supervision, Validation, Writing – review & editing. Funding Information Natural Science Foundation of Fujian Province [http://dx.doi.org/10.13039/501100003392](http://dx.doi.org/10.13039/501100003392)[ ](http://dx.doi.org/10.13039/501100003392)2023J05141 Conflict of Interest | The authors declare that they have no conflict of interest.
The authors | | --- | | Tingxuan Huang1,2, Fenglin Chen1,2, Xin-Yang Liu3, Xiaoxiong Guo1,2, Ping-Hong Zhou3
1 Department of Gastroenterology, Fujian Medical University Union Hospital, Fuzhou, China
2 Fujian Clinical Research Center for Digestive System Tumors and Upper Gastrointestinal Diseases, Fuzhou, China
3 Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
Corresponding author | Ping-Hong Zhou, MD, PhD Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, 180, Fenglin Rd, Shanghai 200032, China [zhou.pinghong@zs-hospital.sh.cn](zhou.pinghong@zs-hospital.sh.cn) References [1] Fuchs KH, Meining A, von Renteln D et al. Euro-NOTES Status Paper: from the concept to clinical practice. Surg Endosc 2013; 27:

FAQs

What patient condition prompted the procedure?

A 57-year-old woman had an incidental 5 mm protrusion at the appendiceal orifice found during routine examination and was asymptomatic.

What key device capability was used in the procedure?

The procedure used a multifunctional integrated snare-knife device combining electrosurgical knife, snare, and injection needle functions throughout NOTES appendectomy.

How long did the procedure take and what were the results?

Appendiceal resection was completed within 30 minutes, with total procedural duration of 60 minutes. Pathology confirmed chronic inflammation with associated abscess formation, and follow-up showed good incision healing at 4 months.

Sep 30, 2026

Uploaded by moss~