lesion, direct the resection in real time and ensure hemostasis. Pathologic examination of the specimen revealed a submucosal artery running perpendicular to the mucosa, classic for a Dieulafoy's lesion. Discussion: Laparoscopic GI resections are becoming standard for both malignant and benign disease. Lumenal lesions in the stomach, small bowel and colon are especially accessible with laparoscopy. Nonanatomical resections present the surgeon with a special challenge. While open surgery allows for palpation of the lesion, laparoscopic surgery relies mostly on visible cues. Endoscopic guidance allows even the most subtle lesions to be identified and precisely excised. This is a powerful tool, as both intra-and extra-luminal views can be obtained simultaneously allowing for a high level of precision. The adequacy of the laparoscopic procedure can be evaluated in real time, allowing for immediate adjustments or revisions to be made when needed. The endoscopic view also increases the safety of the procedure, ensuring lumenal hemostasis and correct anatomical excisions in cases involving the pylorus or ileocecal valve. Endoscopic-guidance provides the surgeon a great deal of versatility, while adding little to operative time and patient morbidity. This technique allows for a minimally invasive approach to complex surgical problems.
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