Colonoscopically Assisted Laparoscopic Polypectomy–An Alternative to Right Hemicolectomy for Large Right-Sided Benign Polyps

A. Z. Kaleem, C. Strachan, L. Whittaker, S. M. Ahmad

Department of Colorectal Surgery, Northern Lincolnshire and Goole Hospital NHS Foundation Trust, Scunthorpe General Hospital, Scunthorpe, UK.

DOI: 10.4236/ss.2013.48069                

Abstract

Introduction: Laparoscopic assisted colonoscopic polypectomies have been well described in the literature and are well established in surgical practice, for removal of large, inaccessible, or flat based polyps. Laparoscope allows the endoscopist a serosal viewpoint and thus clear indication of perforation, in addition to enhancing endoscopic positioning through colonic mobilisation, facilitating polypectomy. We describe a previously rarely published technique, in which the colonoscope directs the surgeon to polyps and laparoscopy enables wedge resection of benign polyps using Endo GIA staplers. Using this method, the colonoscope provides an intra-luminal view ensuring adequate excision with margins whilst the laparoscope provides intra-peritoneal access for the wedge resection. Methods: This is a case series of 12 patients with large tubulovillous adenomas, found and biopsied at colonoscopy. Under a general anaesthetic, an on table colonoscopy was performed to identify and reassess the polyp, whilst a laparoscopy was performed to excise the polyp via wedge resection, using the endoscopic view as guidance. Results: The polyp was identified and completely resected in our 12 patients. All patients were discharged on the first post-operative day. Of the polyps excised, a focus of adenocarcinoma was detected in one and an adjacent endocrine tumour was found in another patient in histology along with tubulovillous adenoma. Rest were all tubulovillous adenomas only. Conclusion: We propose that this technique should be regarded as an alternative to Right hemicolectomies and difficult endoscopic mucosal resections for large adenomas, and be regarded as a definitive and safe procedure in its own right.

Keywords

Colonoscopically Assisted Laparoscopic Polypectomy

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	M. E. Franklin, A. Leyva-Alvizo, et al., “Laparoscopically Monitored Colonoscopic Polypectomy: An Established Form of Endoluminal Therapy for Colorectal Polyps,” Surgical Endoscopy, Vol. 21, No. 9, 2007, pp. 1650-1653. doi:10.1007/s00464-007-9237-5
[2]	British Society of Gastroenterology Guidelines, “Complications of Colonoscopy,” 2006. www.bsg.org
[3]	S. Oka, et al., “Current Status in the Occurrence of Post Operative Bleeding, Perforation, and Local/Residual Recurrence during Colonoscopic Treatment in Japan,” Digestive Endoscopy, Vol. 22, No. 4, 2010, pp. 376-380. doi:10.1111/j.1443-1661.2010.01016.x
[4]	C. Hensman, A. J. Luck and P. J. Hewett, “Laparoscopic Assisted Colonoscopic Polypectomy,” Surgical Endoscopy, Vol. 13, No. 3, 1999, pp. 231-232. doi:10.1007/s004649900951
[5]	M. E. Franklin, J. A. Diaz-E, et al., “Laparoscopic-Assisted Colonoscopic Polypectomy: The Texas Endosurgery Institute Experience,” Diseases of the Colon and Rectum, Vol. 43, No. 9, 2000, pp. 1246-1249. doi:10.1007/BF02237429
[6]	C. J. A. Bowles, R. Leicester et al. “A Prospective Study of Colonoscopy Practice in the UK Today, Are We Prepared for National Colorectal Cancer Screening Tomorrow,” Gut, Vol. 53, No. 2, 2004, pp. 277-283. doi:10.1136/gut.2003.016436
[7]	D. Wilhelm, S. Von Delius, et al., “Combined Laparoscopicendoscopic Resections of Colorectal Polyps: 10 Year Experience and Follow Up,” Surgical Endoscopy, Vol. 23, No. 4, 2009, pp. 688-693. doi:10.1007/s00464-008-0282-5