After Lindsay tries to escape and fails, Heiter explains that he had previously experimented with creating what he called a "three-dog", also joined mouth-to-anus. However, the three-dog died shortly after surgery. Heiter tells Lindsay that one dog tried to escape and that dog became the middle, thus this caused the most pain to the dog and as punishment for her escape attempt, she will become the middle part of his centipede. Heiter performs the surgery, placing Katsuro at the lead, Lindsay in the middle and Jenny at the rear. He removes the front teeth of both women and mutilates the buttocks of both Katsuro and Lindsay in order to provide easier access to the rectums, to which he hideously stitches and grafts their mouths. During his procedure, he severs the ligaments within his victims' knees to prevent leg extension, forcing his victims to crawl. He then connects his victims together in a straight line with their mouths surgically attached to the anus of the victim in front of them.