Combined Endoscopic-Laparoscopic Resection of Colon Polyps

Abstract

Aims: To analyze the current literature on combined endoscopic-laparoscopic resection of colon polyps and to compare this new approach to standard laparoscopic colonic resection for polyps not suitable for endoscopic resection. Results: Several studies demonstrated that with a combined endoscopic-laparoscopic approach, polyps were successfully resected in 82–91% with a low morbidity of 3–10% and a short hospital stay of 1–2 days. Segmental laparoscopic resection was necessary in only 9–12%, but had a conversion rate to open surgery of 15% with an average hospital stay of 6–11 days. A cancerous polyp was found in 6–13% after a combined approach, with lymph node metastasis in 6%. Recurrent polyps after a combined endoscopic-laparoscopic resection seem to be rare, but follow-up of most studies is short and incomplete. Conclusion: Combined endoscopic-laparoscopic resection of colon polyps is feasible, safe, and has a high success rate. Malignant lesions can be treated laparoscopically during the same operation, avoiding the need for a second procedure, and with good long-term oncologic outcome.

Intraoperative colonoscopy in patients with colorectal cancer: Review of recent developments

“…These lesions that are difficult to remove using the standard endoscopic technique are usually candidates for colectomy by the open or laparoscopic approach. However, combined endoscopic‐laparoscopic surgery (CELS) has been developed in recent years as an alternative minimally invasive treatment for these benign lesions . CELS is usually carried out in the operating room, under general anesthesia, and through the cooperation of an endoscopist and a surgeon (in contrast with other IOC, which are usually carried out by surgeons in Japan).…”

“…However, combined endoscopic-laparoscopic surgery (CELS) has been developed in recent years as an alternative minimally invasive treatment for these benign lesions. [39][40][41][42] CELS is usually carried out in the operating room, under general anesthesia, and through the cooperation of an endoscopist and a surgeon (in contrast with other IOC, which are usually carried out by surgeons in Japan). It is broadly classified into two technical variations according to the depth of the bowel wall that is resected: submucosal dissection and full-thickness excision.…”

Collaboration between laparoscopic surgery and endoscopic resection: An evidence‐based review

“…Although ESD is frequently practiced in the East for resection of large colonic polyps, the procedure is technically demanding and the expertise required may not be available in many Western countries. Hence, for large colonic polyps occupying more than one‐third of the bowel circumference or spanning more than two haustral folds, combined endo‐laparoscopic resection is a viable treatment modality . Furthermore, laparoscopy may help maneuver the colon to a more favorable position for endoscopic resection and offer laparoscopic assistance if complete resection is not possible or when perforation occurs.…”

“…Hence, for large colonic polyps occupying more than one-third of the bowel circumference or spanning more than two haustral folds, combined endolaparoscopic resection is a viable treatment modality. [28][29][30] Furthermore, laparoscopy may help maneuver the colon to a more favorable position for endoscopic resection and offer laparoscopic assistance if complete resection is not possible or when perforation occurs. Combined endo-laparoscopic surgery (CELS) may be carried out using several techniques including laparoscopicassisted endoscopic resection, endoscopic-assisted wedge resection, endoscopic-assisted transluminal resection and endoscopic-assisted segmental resection.…”

“…Combined endo‐laparoscopic surgery (CELS) may be carried out using several techniques including laparoscopic‐assisted endoscopic resection, endoscopic‐assisted wedge resection, endoscopic‐assisted transluminal resection and endoscopic‐assisted segmental resection . Overall, success rates in resecting polyps were between 74% and 100%.…”