Minimally Invasive Small Bowel Surgery

  • Jessica S. Crystal
  • Miral Sadaria GrandhiEmail author
Part of the Clinical Gastroenterology book series (CG)


Minimally invasive techniques have been utilized to perform complex abdominal operations with increasing frequency over the past couple of decades. While the fundamental principles of open surgery and minimally invasive surgery are similar, minimally invasive techniques require operating in a confined space through smaller incisions, often maneuvering difficult angles with longer instruments which can increase the complexity of the case. Minimally invasive surgery has been proven to be technically feasible and safe, generally resulting in an overall benefit for patients. However, some operations may require conversion to an open operation, while others may not be able to be attempted in a minimally invasive fashion. Many case series, randomized trials, and systematic reviews have been reported on the topic, leading to the surgical community embracing laparoscopic and robotic surgery to address a variety of surgical disease processes afflicting the small intestinal tract. In this chapter, the minimally invasive approach to small bowel surgery is explored, highlighting the nuances of selecting the appropriate approach to effectively manage each patient. Since the data regarding robotic surgery for small bowel disease processes is limited, this chapter focuses primarily on the laparoscopic approach to small bowel surgery.


Small bowel Minimally invasive Laparoscopic Robotic 


  1. 1.
    Zeni TM, Bemelman WA, Frantzides CT. Chap. 11 Minimally invasive procedures on the small intestine. In: Frantzides CT, Carlson MA, editors. Atlas of minimally invasive surgery. Philadelphia: Saunders Elsevier; 2009. p. 97–101.CrossRefGoogle Scholar
  2. 2.
    Pei KY, Asuzu D, Davis KA. Will laparoscopic lysis of adhesions become the standard of care? Evaluating trends and outcomes in laparoscopic management of small-bowel obstruction using the American College of Surgeons National Surgical Quality Improvement Project Database. Surg Endosc. 2017;31(5):2180–6.CrossRefGoogle Scholar
  3. 3.
    Guo D, Gong J, Cao L, Wei Y, Guo Z, Zhu W. Laparoscopic surgery can reduce postoperative edema compared with open surgery. Gastroenterol Res Pract. 2016.Google Scholar
  4. 4.
    Switzer NJ, Gill RS, Karmali S. The evolution of the appendectomy: from open to laparoscopic to single incision. Scientifica. 2012:Article ID 895469.Google Scholar
  5. 5.
    Dasari BV, McKay D, Gardiner K. Laparoscopic versus open surgery for small bowel Crohn’s disease. Cochrane Database Syst Rev. 2011 Jan 19;1:CD006956.Google Scholar
  6. 6.
    Navez B, Navez J. Laparoscopy in the acute abdomen. Best Pract Res Clin Gastroenterol. 2014;28(1):3–17.CrossRefGoogle Scholar
  7. 7.
    Matsevych OY, Koto MZ, Aldous C. Laparoscopic-assisted approach for penetrating abdominal trauma: A solution for multiple bowel injuries. Int J Surg. 2017;44:94–8.CrossRefGoogle Scholar
  8. 8.
    Cologne KG, Senagore AJ. Development of minimally invasive colorectal surgery: history, evidence, learning curve, and current adaptation. Advanced techniques in minimally invasive and robotic colorectal surgery. New York: Springer; 2015.Google Scholar
  9. 9.
    Bastug DF, Trammell SW, Boland JP, Mantz EP, Tiley EH. 3rd laparoscopic adhesiolysis for small bowel obstruction. Surg Laparosc Endosc. 1991;1:259–62.CrossRefGoogle Scholar
  10. 10.
    Antoniou SA, Antoniou GA, Koch OO, Pointner R, Granderath FA. Is laparoscopic ileocecal resection a safe option for Crohn’s disease? Best evidence topic. Int J Surg. 2014;12(5):22–5.CrossRefGoogle Scholar
  11. 11.
    Ding Y, Zhou Y, Ji Z, Zhang J, Wang Q. Laparoscopic management of perforated Meckel’s diverticulum in adults. Int J Med Sci. 2012;9(3):243–7.CrossRefGoogle Scholar
  12. 12.
    Sun Z, Rodriguez J, McMichael J, Walsh RM, Chalikonda S, Rosenthal RJ, Kroh MD, El-Hayek K. Minimally invasive duodenojejunostomy for superior mesenteric artery syndrome: a case series and review of the literature. Surg Endosc. 2015;29(5):1137–44.CrossRefGoogle Scholar
  13. 13.
    Tabrizian P, Sweeney RE, Uhr JH, Nguyen SQ, Divino CM. Laparoscopic resection of gastric and small bowel gastrointestinal stromal tumors: 10-year experience at a single center. J Am Coll Surg. 2014;218(3):367–73.CrossRefGoogle Scholar
  14. 14.
    Figueiredo MN, Maggiori L, Gaujoux S, Couvelard A, Guedj N, Ruszniewski P, Panis Y. Surgery for small-bowel neuroendocrine tumors: is there any benefit of the laparoscopic approach? Surg Endosc. 2014;28(5):1720–6.CrossRefGoogle Scholar
  15. 15.
    Tsui DK, Tang CN, Ha JP, Li MK. Laparoscopic approach for small bowel tumors. Surg Laparosc Endosc Percutan Tech. 2008;18(6):556–60.CrossRefGoogle Scholar
  16. 16.
    Hamm JK, Chaudhery SI, Kim RH. Laparoscopic resection of small bowel sarcoma. Surg Laparosc Endosc Percutan Tech. 2013;23(3):e138–40.CrossRefGoogle Scholar
  17. 17.
    Abdullah MT, Waqar SH, Zahid MA. Laparoscopy in unexplained abdominal pain: surgeon’s perspective. J Ayub Med Coll Abbottabad. 2016;28(3):461–4.PubMedGoogle Scholar
  18. 18.
    Ayloo SM, Masrur MA, Bianco FM, Giulianotti PC. Robotic Roux-en-Y duodenojejunostomy for superior mesenteric artery syndrome: operative technique. J Laparoendosc Adv Surg Tech A. 2011;21(9):841–4.CrossRefGoogle Scholar
  19. 19.
    Jean RA, O’Neill KM, Pei KY, Davis KA. Impact of hospital volume on outcomes for laparoscopic adhesiolysis for small bowel obstruction. J Surg Res. 2017;214:23–31.CrossRefGoogle Scholar
  20. 20.
    Nagle A, Ujiki M, Denham W, Murayama K. Laparoscopic adhesiolysis for small bowel obstruction. Am J Surg. 2004;187(4):464–70.CrossRefGoogle Scholar
  21. 21.
    Daly SC, Popoff AM, Fogg L, Francescatti AB, Myers JA, Millikan KW, Deziel DJ, Luu MB. Minimally invasive technique leads to decreased morbidity and mortality in small bowel resections compared to an open technique: an ACS-NSQIP identified target for improvement. J Gastrointest Surg. 2014;18(6):1171–5. Scholar
  22. 22.
    Ma Y, Yang Z, Qin H, et al. A meta-analysis of laparoscopy compared with open colorectal resection for colorectal cancer. MedOncol. 2011;28:925–33.Google Scholar
  23. 23.
    Kooby DA, Hawkins WG, Schmidt CM, et al. A multicenter analysis of distal pancreatectomy for adenocarcinoma: Is laparo-scopic resection appropriate? J Am Coll Surg. 2010;210:779–85, 786–777.CrossRefGoogle Scholar
  24. 24.
    Mehrabi A, Hafezi M, Arvin J, et al. A systematic review and meta-analysis of laparoscopic versus open distal pancreatectomy for benign and malignant lesions of the pancreas: It’s time to randomize. Surgery. 2015;157:45–55.CrossRefGoogle Scholar
  25. 25.
    Spolverato G, Kim Y, Ejaz A, et al. A multi-institutional analysis of open versus minimally-invasive surgery for gastric adenocarcinoma: Results of the US gastric cancer collaborative. J Gastrointest Surg. 2014;18:1563–74.CrossRefGoogle Scholar
  26. 26.
    Matlok M, Stanek M, Pedziwiatr M, Major P, Kulawik J, Budzynski P. Laparoscopic surgery in the treatment of gastrointestinal stromal tumors. Scand J Surg. 2015;104(3):185–90.CrossRefGoogle Scholar
  27. 27.
    Shamiyeh A, Gabriel M. Laparoscopic resection of gastrointestinal neuroendocrine tumors with special contribution of radionuclide imaging. World J Gastroenterol. 2014;20(42):15608–15.CrossRefGoogle Scholar
  28. 28.
    Reissman P, Shmailov S, Grozinsky-Glasberg S, Gross DJ. Laparoscopic resection of primary midgut carcinoid tumors. Surg Endosc. 2013;27(10):3678–82.CrossRefGoogle Scholar
  29. 29.
    Napolitano L, Waku M, De Nicola P, Di Bartolomeo N, Aceto L, Innocenti P. Surgical laparoscopic therapy of small bowel tumors: review of the literature and report of two cases. G Chir. 2004;25(6–7):235–7.PubMedGoogle Scholar
  30. 30.
    Felsher J, Brodsky J, Brody F. Laparoscopic small bowel resection of metastatic pulmonary carcinosarcoma. J Laparoendosc Adv Surg Tech A. 2003;13(6):397–400.CrossRefGoogle Scholar
  31. 31.
    Hosn MA, Lakis M, Faraj W, Khoury G, Diba S. Laparoscopic approach to symptomatic Meckel diverticulum in adults. JSLS. 2014;18(4). pii: e2014.00349.CrossRefGoogle Scholar
  32. 32.
    Papparella A, Nino F, Noviello C, Marte A, Parmeggiani P, Martino A, Cobellis G. Laparoscopic approach to Meckel’s diverticulum. World J Gastroenterol. 2014;20(25):8173–8. Scholar
  33. 33.
    Chan KW, Lee KH, Mou JW, Cheung ST, Tam YH. Laparoscopic management of complicated Meckel’s diverticulum in children: a 10-year review. Surg Endosc. 2008;22(6):1509–12.CrossRefGoogle Scholar
  34. 34.
    Alemayehu H, Stringel G, Lo IJ, Golden J, Pandya S, McBride W, Muensterer O. Laparoscopy and complicated Meckel diverticulum in children. JSLS. 2014;18(3):e2014.00015.CrossRefGoogle Scholar
  35. 35.
    Guidelines for Laparoscopic Appendectomy. © 2017 Society of American Gastrointestinal and Endoscopic Surgeon.
  36. 36.
    Bucher P, Mathe Z, Demirag A, Morel PH. Appendix tumors in the era of laparoscopic appendectomy. Surg Endosc. 2004;18(7):1063–6.CrossRefGoogle Scholar
  37. 37.
    Grozinsky-Glasberg S, Alexandraki KI, Barak D, Doviner V, Reissman P, Kaltsas GA, Gross DJ. Current size criteria for the management of neuroendocrine tumors of the appendix: are they valid? Clinical experience and review of the literature. Neuroendocrinology. 2013;98(1):31–7.CrossRefGoogle Scholar
  38. 38.
    Park KJ, Choi HJ, Kim SH. Laparoscopic approach to mucocele of appendiceal mucinous cystadenoma: feasibility and short-term outcomes in 24 consecutive cases. Surg Endosc. 2015;29(11):3179–83.CrossRefGoogle Scholar
  39. 39.
    Nitecki SS, Wolff BG, Schlinkert R, Sarr MG. The natural history of surgically treated primary adenocarcinoma of the appendix. Ann Surg. 1994;219:51–7.CrossRefGoogle Scholar
  40. 40.
    Ertem M, Ozben V, Ozveri E, Yilmaz S. Application of laparoscopy in the management of obscure gastrointestinal bleeding. Surg Laparosc Endosc Percutan Tech. 2010;20(2):89–92.CrossRefGoogle Scholar
  41. 41.
    Masrur M, Daskalaki D, Vannucchi A, Vannemreddy SN, Gonzalez-Ciccarelli LF, Brown R, Giulianotti PC. Minimally invasive treatment of difficult bleeding lesions of the small bowel. Minerva Chir. 2016;71(5):293–9.Google Scholar
  42. 42.
    Dural AC, Çelik MF, Yiğitbaş H, Akarsu C, Doğan M, Alış H. Laparoscopic resection and intracorporeal anastomosis of perforated small bowel caused by fish bone ingestion. Ulus Travma Acil Cerrahi Derg. 2016;22(6):572–4.PubMedGoogle Scholar
  43. 43.
    Wichmann MW, Hüttl TP, Billing A, Jauch KW. Laparoscopic management of a small bowel perforation caused by a toothpick. Surg Endosc. 2004;18(4):717–8.CrossRefGoogle Scholar
  44. 44.
    Coisy M, Bourgouin S, Chevance J, Balandraud P. Laparoscopic management of gallstone ileus. J Gastrointest Surg. 2016;20(2):476–8.CrossRefGoogle Scholar
  45. 45.
    Bircan HY, Koc B, Ozcelik U, Kemik O, Demirag A. Laparoscopic treatment of gallstone ileus. Clin Med Insights Case Rep. 2014;7:75–7.PubMedPubMedCentralGoogle Scholar
  46. 46.
    Siow SL, Mahendran HA. A case series of adult intussusception managed laparoscopically. Surg Laparosc Endosc Percutan Tech. 2014;24(4):327–31.CrossRefGoogle Scholar
  47. 47.
    Schmidt CM, Talamini MA, Kaufman HS, Lilliemoe KD, Learn P, Bayless T. Laparoscopic surgery for Crohn’s disease: reasons for conversion. Ann Surg. 2001;233(6):733–9.CrossRefGoogle Scholar
  48. 48.
    Evans J, Poritz L, MacRae H. Influence of experience on laparoscopic ileocolic resection for Crohn’s disease. Dis Colon Rectum. 2002;45(12):1595–600.CrossRefGoogle Scholar
  49. 49.
    Rashidi L, Neighorn C, Bastawrous A. Outcome comparisons between high-volume robotic and laparoscopic surgeons in a large healthcare system. Am J Surg. 2017;213(5):901–5.CrossRefGoogle Scholar
  50. 50.
    Perugini RA, Callery MP. Complications of laparoscopic surgery. Surgical treatment: evidence-based and problem-oriented. In: Holzheimer RG, Mannick JA, editors. Surgical treatment: evidence-based and problem-oriented. Munich: Zuckschwerdt; 2001.Google Scholar
  51. 51.
    Cirocchi R, Abraha I, Farinella E, Montedori A, Sciannameo F. Laparoscopic versus open surgery in small bowel obstruction. Cochrane Database Syst Rev. 2010;2:CD007511.Google Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of SurgeryRutgers Robert Wood Johnson Medical SchoolNew BrunswickUSA
  2. 2.Department of Surgery, Division of Surgical OncologyRutgers Cancer Institute of New JerseyNew BrunswickUSA

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