TITLE:
Colonoscopically Assisted Laparoscopic Polypectomy–An Alternative to Right Hemicolectomy for Large Right-Sided Benign Polyps
AUTHORS:
A. Z. Kaleem, C. Strachan, L. Whittaker, S. M. Ahmad
KEYWORDS:
Colonoscopically Assisted Laparoscopic Polypectomy
JOURNAL NAME:
Surgical Science,
Vol.4 No.8,
July
23,
2013
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.