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Principles of Flexible Endoscopy for Surgeons pp 167–181Cite as

Intraoperative Endoscopy

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Abstract

The intraoperative use of flexible gastrointestinal endoscopes holds significant value for patients and surgeons alike. At its extreme, intraoperative endoscopy serves as the platform that allows for performance of novel procedures like natural orifice surgery, and endoluminal procedures such as transoral fundoplication and gastric volume reduction. While the appeal of performing advanced futuristic procedures may promote an interest in using flexible gastrointestinal endoscopes in the operating room for some surgeons, it is the use of these devices during routine operations on the gastrointestinal tract that will immediately and positively impact patient care.

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Author information

Authors and Affiliations

  1. Minimally Invasive Surgery and Surgical Endoscopy, Department of Surgery, The Guthrie Clinic Ltd., One Guthrie Square, Sayre, PA, 18840, USA

    Robert D. Fanelli M.D., F.A.C.S., F.A.S.G.E. (Chief)

Authors
  1. Robert D. Fanelli M.D., F.A.C.S., F.A.S.G.E.
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Corresponding author

Correspondence to Robert D. Fanelli M.D., F.A.C.S., F.A.S.G.E. .

Editor information

Editors and Affiliations

  1. Department of Surgery, University Hospitals Case Medical Center, Cleveland, Ohio, USA

    Jeffrey M. Marks

  2. The Methodist Hospital, Methodist Institute for Technology, Innovation and Education, Houston, Texas, USA

    Brian J. Dunkin

Electronic Supplementary Material

Below is the link to the electronic supplementary material.

216787_1_En_15_MOESM1_ESM.mpeg

Intraoperative EGD is performed during laparoscopic esophageal myotomy for achalasia. The esophageal lumen distends during insufflation, additional irrigation is used to keep the esophageal wall immersed for leak testing, and the insufflated gas is evacuated upon completion (MPEG 124048 kb)

216787_1_En_15_MOESM2_ESM.mpeg

Intraoperative EGD during laparoscopic Roux en Y gastric bypass for morbid obesity. Soon after insufflating the gastric pouch, carbon dioxide is seen collecting beneath the omentum, then bubbling freely within the operative field. Suction is used to expose the staple-line defect, which was quickly repaired with a single suture, precluding delayed diagnosis and its associated consequences (MPEG 39872 kb)

216787_1_En_15_MOESM3_ESM.mpeg

Laparoscopically assisted transoral enteroscopy. As the pediatric colonoscope is passed using minimal insufflation, atraumatic laparoscopic graspers are used to advance loops of jejunum onto the endoscope (MPEG 23656 kb)

Intraoperative colonoscopy after laparoscopic anterior resection of the rectum with ultra-low coloanal anastomosis. The author’s gloved finger is seen at the anal os, followed by creation of a transanal stapled anastomosis. Note gentle colonic insufflation with carbon dioxide, endoscopic inspection of the anastomosis, and underwater leak testing. A diverting ileostomy was placed despite favorable endoscopic findings, to address the risks inherent in ultra-low anastomoses, and those related to malignancy, radiation, and chemotherapy (MPEG 45186 kb)

Video 15.1

Intraoperative EGD is performed during laparoscopic esophageal myotomy for achalasia. The esophageal lumen distends during insufflation, additional irrigation is used to keep the esophageal wall immersed for leak testing, and the insufflated gas is evacuated upon completion (MPEG 124048 kb)

Video 15.2

Intraoperative EGD during laparoscopic Roux en Y gastric bypass for morbid obesity. Soon after insufflating the gastric pouch, carbon dioxide is seen collecting beneath the omentum, then bubbling freely within the operative field. Suction is used to expose the staple-line defect, which was quickly repaired with a single suture, precluding delayed diagnosis and its associated consequences (MPEG 39872 kb)

Video 15.3

Laparoscopically assisted transoral enteroscopy. As the pediatric colonoscope is passed using minimal insufflation, atraumatic laparoscopic graspers are used to advance loops of jejunum onto the endoscope (MPEG 23656 kb)

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Fanelli, R.D. (2013). Intraoperative Endoscopy. In: Marks, J., Dunkin, B. (eds) Principles of Flexible Endoscopy for Surgeons. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-6330-6_15

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  • DOI: https://doi.org/10.1007/978-1-4614-6330-6_15

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  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4614-6329-0

  • Online ISBN: 978-1-4614-6330-6

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