Abstract
Colonoscopic polypectomy is the treatment of choice for diagnosing and removing most colon polyps. Large polyps or those in an anatomically difficult location can be very challenging to remove by endoscopic techniques alone. Traditionally, the most common recommendation for these patients has been to undergo a segmental colon resection. Although the laparoscopic approach has reduced the morbidity of an abdominal operation, it still poses potential morbidities related to bowel resection. A combined approach using both laparoscopy and colonoscopy (combined endoscopic and laparoscopic surgery, CELS) has been described as an alternative to bowel resection in select patients with polyps that cannot be removed endoscopically. Polyp removal using this combined approach may be an effective alternative in select patients.
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Video 5.1 Polypectomy in the Ascending Colon Using Combined Endoscopic and Laparoscopic Surgery (CELS): A 4 cm sessile polyp is visualized in the ascending colon. Laparoscopic ports are placed, and the right colon is mobilized for improved laparoscopic bowel manipulation (this aspect not shown in video). A submucosal injection is performed using a mixture saline and indigo carmine solution. Using laparoscopic instruments to stabilize the bowel and improve endoscopic visualization, a snare polypectomy is performed in a piecemeal fashion. The polypectomy pieces are retrieved using a Roth net (WMV 149517 kb).
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Garrett, K.A., Lee, S.W. (2014). Combined Endoscopic and Laparoscopic Surgery (CELS). In: Sonoda, T. (eds) Advanced Colonoscopy. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-1584-2_5
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DOI: https://doi.org/10.1007/978-1-4939-1584-2_5
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