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. 2022 Jan 14;10(1):E119–E126. doi: 10.1055/a-1548-5552

Fig. 4.

Fig. 4

 A case of tunneling diverticulotomy with ultra-short tunnel. a Submucosal injection at the apex of the septum. b Tunnel initiation is undertaken. After incision of the mucosa, injection is undertaken on both sides of the muscular septum to isolate and clearly define the muscle, which is then incised. Incision of the muscle is necessary to establish the tunnel proximally since the submucosal portion of the tunnel is only a few mm (equal to the thickness of the injected submucosa at the apex of the septum). c We perform simultaneous dissection of the muscle and submucosa on either side of the muscle extending the tunnel distally. d Completion of tunnel/myotomy. The end of the muscle incision at the tunnel terminus can be seen through the tunnel opening. e , f Tunnel closure with clips is facilitated by the en face location of the tunnel opening in this ultra-short tunnel technique which is our preferred technique.