Endoscopic transcecal appendectomy: the first human case report

A 53-year-old man was transferred to our hospital for the management of a cecal polyp near the appendiceal orifice. At colonoscopy, no appendiceal orifice was seen; instead, a mucosal bulge was seen (A). An appendiceal cyst was considered. Because the appendiceal lumen directly connects to the cecum, colonoscopic appendectomy was considered. After informed consent was obtained from the patient, an endoscopic full-thickness incision was made around the appendiceal orifice with a Hook (Olympus, Tokyo, Japan) and IT2 knife (Olympus, Tokyo, Japan). After full-thickness dissection, the endoscope was inserted into the peritoneal cavity, where an enlarged appendix was seen. A circuit dissection was done along the outside of the appendix, and the appendix was separated from the mesoappendix by use of an IT2 knife with snare traction assistance (B). Hemostasis was obtained by endoscopic electric coagulation. After complete dissection, the appendix was pulled into the colon (C) and removed through the anus (D). The cecal defect was closed with endoclips and endoloops. The pathologic diagnosis was appendiceal retention cyst. The patient recovered without incident and was discharged after 3 days.