Combined Endo-Laparoscopic Surgery (CELS)
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 subsequent 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 endo-laparoscopic surgery, CELS) has more recently been described as an alternative to bowel resection in select patients with polyps that cannot be removed endoscopically. This procedure allows laparoscopic manipulation of the colon wall adjacent to the polyp to facilitate polypectomy. Furthermore, it enables prompt diagnosis and treatment of full-thickness defects of the colon and provides an opportunity to proceed with a standard oncological resection in lesions that are not amenable or suitable for this CELS. In this chapter, we will review this technique including key points for success.
KeywordsLaparoscopic Colectomy Final Pathology Open Colectomy Segmental Colectomy Colonoscopic Polypectomy
Combined endo-laparoscopic-assisted polypectomy (MP4 106,865 kb)