Intraoperative Endoscopy

  • Robert D. FanelliEmail author


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.


Common Bile Duct Common Bile Duct Stone Mechanical Bowel Preparation Common Bile Duct Exploration Wireless Capsule Endoscopy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Supplementary material

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)
Video 15.4

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)

Suggested Reading

  1. 1.
    Cingi A, Yavuz Y. Intraoperative endoscopic assessment of the pouch and anastomosis during laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2011;21(10):1530–4.PubMedCrossRefGoogle Scholar
  2. 2.
    Del Rio P, Dell’Abate P, Labonia D, et al. Choledocholithiasis and endo-laparoscopic rendezvous. Analysis of 59 consecutive cases. Ann Ital Chir. 2011;82(3):221–4.PubMedGoogle Scholar
  3. 3.
    Alfa MJ, Sepehri S, Olson N, Wald A. Establishing a clinically relevant bioburden benchmark: a quality indicator for adequate reprocessing and storage of flexible gastrointestinal endoscopes. Am J Infect Control. 2012;40(3):233–6.PubMedCrossRefGoogle Scholar
  4. 4.
    Alasfar F, Chand B. Intraoperative endoscopy for laparoscopic Roux-en-Y gastric bypass: leak test and beyond. Surg Laparosc Endosc Percutan Tech. 2010;20(6):424–7.PubMedCrossRefGoogle Scholar
  5. 5.
    Borzellino G, Rodella L, Saladino E, et al. Treatment for retained [corrected] common bile duct stones during laparoscopic cholecystectomy: the rendezvous technique. Arch Surg. 2010;145(12):1145–9.PubMedCrossRefGoogle Scholar
  6. 6.
    Nishikawa K, Yanaga K, Kashiwagi H, Hanyuu N, Iwabuchi S. Significance of intraoperative endoscopy in total gastrectomy for gastric cancer. Surg Endosc. 2010;24(10):2633–6.PubMedCrossRefGoogle Scholar
  7. 7.
    Levitzky BE, Wassef WY. Endoscopic management in the bariatric surgical patient. Curr Opin Gastroenterol. 2010;26(6):632–9.PubMedCrossRefGoogle Scholar
  8. 8.
    Borzellino G, Rodella L, Saladino E, et al. Treatment for retained [corrected] common bile duct stones during laparoscopic cholecystectomy: the rendezvous technique. Arch Surg. 2010;145(12):1145–9.PubMedCrossRefGoogle Scholar
  9. 9.
    Tzovaras G, Baloyiannis I, Kapsoritakis A, Psychos A, Paroutoglou G, Potamianos S. Laparoendoscopic rendezvous: an effective alternative to a failed preoperative ERCP in patients with cholecystocholedocholithiasis. Surg Endosc. 2010;24(10):2603–6.PubMedCrossRefGoogle Scholar
  10. 10.
    Greenwald D. Reducing infection risk in colonoscopy. Gastrointest Endosc Clin N Am. 2010;20(4):603–14.PubMedCrossRefGoogle Scholar
  11. 11.
    Ferenc J. Endoscopes require constant care. Hospitals must remain vigilant: ECRI institute. Mater Manag Health Care. 2010;19(2):24–5.PubMedGoogle Scholar
  12. 12.
    Adikibi BT, MacKinlay GA, Munro FD, Khan LR, Gillett PM. Intraoperative upper GI endoscopy ensures an adequate laparoscopic Heller’s myotomy. J Laparoendosc Adv Surg Tech A. 2009;19(5):687–9.PubMedCrossRefGoogle Scholar
  13. 13.
    Alaedeen D, Madan AK, Ro CY, Khan KA, Martinez JM, Tichansky DS. Intraoperative endoscopy and leaks after laparoscopic Roux-en-Y gastric bypass. Am Surg. 2009;75(6):485–8; discussion 488.PubMedGoogle Scholar
  14. 14.
    DiMaggio V, Hoffman K, Baxter R, Cekic V, Nasar A, Whelan RL. Increased utilization of flexible endoscopic methods during colorectal resection over a 3-year period. Surg Innov. 2009;16(4):293–8.PubMedCrossRefGoogle Scholar
  15. 15.
    Eisenberg D, Bell R. Intraoperative endoscopy: a requisite tool for laparoscopic resection of unusual gastrointestinal lesions—a case series. J Surg Res. 2009;155(2):318–20.PubMedCrossRefGoogle Scholar
  16. 16.
    Souma Y, Nakajima K, Takahashi T, et al. The role of intraoperative carbon dioxide insufflating upper gastrointestinal endoscopy during laparoscopic surgery. Surg Endosc. 2009;23(10):2279–85.PubMedCrossRefGoogle Scholar
  17. 17.
    Li VK, Wexner SD, Pulido N, et al. Use of routine intraoperative endoscopy in elective laparoscopic colorectal surgery: can it further avoid anastomotic failure? Surg Endosc. 2009;23(11):2459–65.PubMedCrossRefGoogle Scholar
  18. 18.
    Ghazal AH, Sorour MA, El-Riwini M, El-Bahrawy H. Single-step treatment of gall bladder and bile duct stones: a combined endoscopic-laparoscopic technique. Int J Surg. 2009;7(4):338–46.PubMedCrossRefGoogle Scholar
  19. 19.
    Wilhelm D, von Delius S, Burian M, et al. Simultaneous use of laparoscopy and endoscopy for minimally invasive resection of gastric subepithelial masses—analysis of 93 interventions. World J Surg. 2008;32(6):1021–8.PubMedCrossRefGoogle Scholar
  20. 20.
    Banerjee S, Shen B, Baron TH, et al. Antibiotic prophylaxis for GI endoscopy. Gastrointest Endosc. 2008;67(6):791–8.PubMedCrossRefGoogle Scholar
  21. 21.
    Banerjee S, Shen B, Nelson DB, et al. Infection control during GI endoscopy. Gastrointest Endosc. 2008;67(6):781–90.PubMedCrossRefGoogle Scholar
  22. 22.
    Dominitz JA, Ikenberry SO, Anderson MA, et al. Renewal of and proctoring for endoscopic privileges. Gastrointest Endosc. 2008;67(1):10–6.PubMedCrossRefGoogle Scholar
  23. 23.
    SAGES. Granting of privilege for gastrointestinal endoscopy. Surg Endosc. 2008;22(5):1349–52.CrossRefGoogle Scholar
  24. 24.
    del Genio G, Rossetti G, Brusciano L, et al. Laparoscopic Nissen-Rossetti fundoplication with routine use of intraoperative endoscopy and manometry: technical aspects of a standardized technique. World J Surg. 2007;31(5):1099–106.PubMedGoogle Scholar
  25. 25.
    Osborne S, Reynolds S, George N, Lindemayer F, Gill A, Chalmers M. Challenging endoscopy reprocessing guidelines: a prospective study investigating the safe shelf life of flexible endoscopes in a tertiary gastroenterology unit. Endoscopy. 2007;39(9):825–30.PubMedCrossRefGoogle Scholar
  26. 26.
    Zuckerman MJ, Shen B, Harrison 3rd ME, et al. Informed consent for GI endoscopy. Gastrointest Endosc. 2007;66(2):213–8.PubMedCrossRefGoogle Scholar
  27. 27.
    Lyass S, Phillips EH. Laparoscopic transcystic duct common bile duct exploration. Surg Endosc. 2006;20 Suppl 2:S441–5.PubMedCrossRefGoogle Scholar
  28. 28.
    Morino M, Baracchi F, Miglietta C, Furlan N, Ragona R, Garbarini A. Preoperative endoscopic sphincterotomy versus laparoendoscopic rendezvous in patients with gallbladder and bile duct stones. Ann Surg. 2006;244(6):889–93; discussion 893–886.PubMedCrossRefPubMedCentralGoogle Scholar
  29. 29.
    Rabago LR, Vicente C, Soler F, et al. Two-stage treatment with preoperative endoscopic retrograde cholangiopancreatography (ERCP) compared with single-stage treatment with intraoperative ERCP for patients with symptomatic cholelithiasis with possible choledocholithiasis. Endoscopy. 2006;38(8):779–86.PubMedCrossRefGoogle Scholar
  30. 30.
    Alimoglu O, Sahin M, Cefle K, Celik O, Eryilmaz R, Palanduz S. Peutz-Jeghers syndrome: report of 6 cases in a family and management of polyps with intraoperative endoscopy. Turk J Gastroenterol. 2004;15(3):164–8.PubMedGoogle Scholar
  31. 31.
    Bloomston M, Brady P, Rosemurgy AS. Videoscopic Heller myotomy with intraoperative endoscopy promotes optimal outcomes. JSLS. 2002;6(2):133–8.PubMedPubMedCentralGoogle Scholar
  32. 32.
    Fanelli RD, Gersin KS, Mainella MT. Laparoscopic endobiliary stenting significantly improves success of postoperative endoscopic retrograde cholangiopancreatography in low-volume centers. Surg Endosc. 2002;16(3):487–91.PubMedCrossRefGoogle Scholar
  33. 33.
    Wexner SD, Eisen GM, Simmang C. Principles of privileging and credentialing for endoscopy and colonoscopy. Surg Endosc. 2002;16(2):367–9.PubMedCrossRefGoogle Scholar
  34. 34.
    Eisen GM, Baron TH, Dominitz JA, et al. Methods of granting hospital privileges to perform gastrointestinal endoscopy. Gastrointest Endosc. 2002;55(7):780–3.PubMedCrossRefGoogle Scholar
  35. 35.
    Fanelli RD, Gersin KS. Laparoscopic endobiliary stenting: a simplified approach to the management of occult common bile duct stones. J Gastrointest Surg. 2001;5(1):74–80.PubMedCrossRefGoogle Scholar
  36. 36.
    Wexner SD, Garbus JE, Singh JJ. A prospective analysis of 13,580 colonoscopies. Reevaluation of credentialing guidelines. Surg Endosc. 2001;15(3):251–61.PubMedCrossRefGoogle Scholar
  37. 37.
    Himal HS. Common bile duct stones: the role of preoperative, intraoperative, and postoperative ERCP. Semin Laparosc Surg. 2000;7(4):237–45.PubMedCrossRefGoogle Scholar
  38. 38.
    Park AE, Mastrangelo Jr MJ. Endoscopic retrograde cholangiopancreatography in the management of choledocholithiasis. Surg Endosc. 2000;14(3):219–26.PubMedGoogle Scholar
  39. 39.
    Walter VA, DiMarino Jr AJ. American Society for Gastrointestinal Endoscopy-Society of Gastroenterology Nurses and Associates Endoscope Reprocessing Guidelines. Gastrointest Endosc Clin N Am. 2000;10(2):265–73.PubMedGoogle Scholar
  40. 40.
    Alvarado A. Intraoperative endoscopy during colorectal surgery. Surg Laparosc Endosc Percutan Tech. 1999;9(2):165.PubMedGoogle Scholar
  41. 41.
    Alves A, Perniceni T, Godeberge P, Mal F, Levy P, Gayet B. Laparoscopic Heller’s cardiomyotomy in achalasia. Is intra­operative endoscopy useful, and why? Surg Endosc. 1999;13(6):600–3.PubMedCrossRefGoogle Scholar
  42. 42.
    Delmotte JS, Gay GJ, Houcke PH, Mesnard Y. Intraoperative endoscopy. Gastrointest Endosc Clin N Am. 1999;9(1):61–9.PubMedGoogle Scholar
  43. 43.
    Crawford DL, Phillips EH. Laparoscopic common bile duct exploration. World J Surg. 1999;23(4):343–9.PubMedCrossRefGoogle Scholar
  44. 44.
    Forde KA. Intraoperative endoscopy: a continuing need in colorectal surgery. Cancer Invest. 1998;16(1):62–3.PubMedCrossRefGoogle Scholar
  45. 45.
    Phillips EH. Laparoscopic transcystic duct common bile duct exploration. Surg Endosc. 1998;12(4):365–6.PubMedCrossRefGoogle Scholar
  46. 46.
    Wexner SD, Forde KA, Sellers G, et al. How well can surgeons perform colonoscopy? Surg Endosc. 1998;12(12):1410–4.PubMedCrossRefGoogle Scholar
  47. 47.
    Phillips EH, Rosenthal RJ, Carroll BJ, Fallas MJ. Laparoscopic trans-cystic-duct common-bile-duct exploration. Surg Endosc. 1994;8(12):1389–93; discussion 1393–1384.PubMedGoogle Scholar
  48. 48.
    Bombeck CT. Intraoperative esophagoscopy, gastroscopy, colonoscopy, and endoscopy of the small bowel. Surg Clin North Am. 1975;55(1):135–42.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  1. 1.Minimally Invasive Surgery and Surgical Endoscopy, Department of SurgeryThe Guthrie Clinic Ltd.SayreUSA

Personalised recommendations