Skip to main content

Minimally Invasive Surgical Techniques for Cancers of the Small Intestine

  • 1959 Accesses


The rarity of small intestinal malignancies and the advanced nature at presentation have traditionally limited the use of laparoscopic operations in dealing with cancers of the small intestine. However, in the recent past, with advanced experience and improved technology, laparoscopic surgery for these disorders is gaining popularity in mainstream practice. This chapter provides an insight into the disease processes, diagnosis, and treatment of small intestinal neoplasms, while giving a step-by-step description on performing these complex procedures using minimally invasive surgical techniques.


  • Small bowel cancer
  • Laparoscopic
  • Jejunum
  • Ileum
  • Technique

Dilendra H. Weerasinghe is supported by a grant from the Foundation for Surgical Fellowships.

This is a preview of subscription content, access via your institution.

Buying options

USD   29.95
Price excludes VAT (USA)
  • DOI: 10.1007/978-1-4939-1893-5_14
  • Chapter length: 10 pages
  • Instant PDF download
  • Readable on all devices
  • Own it forever
  • Exclusive offer for individuals only
  • Tax calculation will be finalised during checkout
USD   99.00
Price excludes VAT (USA)
  • ISBN: 978-1-4939-1893-5
  • Instant PDF download
  • Readable on all devices
  • Own it forever
  • Exclusive offer for individuals only
  • Tax calculation will be finalised during checkout
Softcover Book
USD   129.00
Price excludes VAT (USA)
Fig. 14.1
Fig. 14.2
Fig. 14.3
Fig. 14.4
Fig. 14.5
Fig. 14.6


  1. Dietz UA, Debus ES. Intestinal anastomoses prior to 1882; a legacy of ingenuity, persistence, and research form a foundation for modern gastrointestinal surgery. World J Surg. 2005;29(3):396–401. doi:10.1007/s00268-004-7720-x.

    PubMed  CrossRef  Google Scholar 

  2. Himal HS. Minimally invasive (laparoscopic) surgery. Surg Endosc. 2002;16(12):1647–52. doi:10.1007/s00464-001-8275-7.

    CAS  PubMed  CrossRef  Google Scholar 

  3. Fleshman J, Sargent DJ, Green E, Anvari M, Stryker SJ, Beart Jr RW, et al. Laparoscopic colectomy for cancer is not inferior to open surgery based on 5-year data from the COST Study Group trial. Ann Surg. 2007;246(4):655–62. doi:10.1097/SLA.0b013e318155a762; discussion 62–4.

    PubMed  CrossRef  Google Scholar 

  4. Clinical Outcomes of Surgical Therapy Study Group. A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med. 2004;350(20):2050–9. doi:10.1056/NEJMoa032651.

    CrossRef  Google Scholar 

  5. Bilimoria KY, Bentrem DJ, Wayne JD, Ko CY, Bennett CL, Talamonti MS. Small bowel cancer in the United States: changes in epidemiology, treatment, and survival over the last 20 years. Ann Surg. 2009;249(1):63–71. doi:10.1097/SLA.0b013e31818e4641.

    PubMed  CrossRef  Google Scholar 

  6. Kim CH, Kye BH, Lee JI, Kim SH, Kim HJ, Kang WK, et al. Clinicopathological features of primary jejunoileal tumors. J Korean Soc Coloproctol. 2010;26(5):334–8. doi:10.3393/jksc.2010.26.5.334.

    PubMed Central  PubMed  CrossRef  Google Scholar 

  7. Catena F, Ansaloni L, Gazzotti F, Gagliardi S, Di Saverio S, De Cataldis A, et al. Small bowel tumours in emergency surgery: specificity of clinical presentation. ANZ J Surg. 2005;75(11):997–9. doi:10.1111/j.1445-2197.2005.03590.x.

    PubMed  CrossRef  Google Scholar 

  8. Han SL, Cheng J, Zhou HZ, Guo SC, Jia ZR, Wang PF. Surgically treated primary malignant tumor of small bowel: a clinical analysis. World J Gastroenterol. 2010;16(12):1527–32.

    PubMed Central  PubMed  CrossRef  Google Scholar 

  9. Eliakim R. Video capsule endoscopy of the small bowel. Curr Opin Gastroenterol. 2008;24(2):159–63. doi:10.1097/MOG.0b013e3282f3d946.

    PubMed  CrossRef  Google Scholar 

  10. Gill SS, Heuman DM, Mihas AA. Small intestinal neoplasms. J Clin Gastroenterol. 2001;33(4):267–82.

    CAS  PubMed  CrossRef  Google Scholar 

  11. Mustafa BF, Samaan M, Langmead L, Khasraw M. Small bowel video capsule endoscopy: an overview. Expert Rev Gastroenterol Hepatol. 2013;7(4):323–9. doi:10.1586/egh.13.20.

    CAS  PubMed  CrossRef  Google Scholar 

  12. Cho MY, Kim JM, Sohn JH, Kim MJ, Kim KM, Kim WH, et al. Current trends of the incidence and pathological diagnosis of gastroenteropancreatic neuroendocrine tumors (GEP-NETs) in Korea 2000–2009: multicenter study. Cancer Res Treat. 2012;44(3):157–65. doi:10.4143/crt.2012.44.3.157.

    PubMed Central  PubMed  CrossRef  Google Scholar 

  13. Scherubl H, Streller B, Stabenow R, Herbst H, Hopfner M, Schwertner C, et al. Clinically detected gastroenteropancreatic neuroendocrine tumors are on the rise: epidemiological changes in Germany. World J Gastroenterol. 2013;19(47):9012–9. doi:10.3748/wjg.v19.i47.9012.

    PubMed Central  PubMed  CrossRef  Google Scholar 

  14. Overman MJ. Recent advances in the management of adenocarcinoma of the small intestine. Gastrointest Cancer Res. 2009;3(3):90–6.

    PubMed Central  PubMed  Google Scholar 

  15. Kelsey CR, Nelson JW, Willett CG, Chino JP, Clough RW, Bendell JC, et al. Duodenal adenocarcinoma: patterns of failure after resection and the role of chemoradiotherapy. Int J Radiat Oncol Biol Phys. 2007;69(5):1436–41. doi:10.1016/j.ijrobp.2007.05.006.

    PubMed  CrossRef  Google Scholar 

  16. Dawson IM, Cornes JS, Morson BC. Primary malignant lymphoid tumours of the intestinal tract. Report of 37 cases with a study of factors influencing prognosis. Br J Surg. 1961;49:80–9.

    CAS  PubMed  CrossRef  Google Scholar 

  17. Beaton C, Davies M, Beynon J. The management of primary small bowel and colon lymphoma—a review. Int J Colorectal Dis. 2012;27(5):555–63. doi:10.1007/s00384-011-1309-2.

    PubMed  CrossRef  Google Scholar 

  18. Koch P, del Valle F, Berdel WE, Willich NA, Reers B, Hiddemann W, et al. Primary gastrointestinal non-Hodgkin’s lymphoma: II. Combined surgical and conservative or conservative management only in localized gastric lymphoma—results of the prospective German Multicenter Study GIT NHL 01/92. J Clinical Oncol. 2001;19(18):3874–83.

    CAS  Google Scholar 

  19. Awad ZT, Qureshi I, Seibel B, Sharma S, Dobbertien MA. Laparoscopic right hemicolectomy with transvaginal colon extraction using a laparoscopic posterior colpotomy: a 2-year series from a single institution. Surg Laparosc Endosc Percutan Tech. 2011;21(6):403–8. doi:10.1097/SLE.0b013e31823945ac.

    PubMed  CrossRef  Google Scholar 

  20. Lujan JJ, Nemeth ZH, Barratt-Stopper PA, Bustami R, Koshenkov VP, Rolandelli RH. Factors influencing the outcome of intestinal anastomosis. Am Surg. 2011;77(9):1169–75.

    PubMed  Google Scholar 

  21. Pandey R, Kochar R. Management of gastrointestinal stromal tumors: looking beyond the knife. An update on the role of adjuvant and neoadjuvant imatinib therapy. J Gastrointest Cancer. 2012;43(4):547–52. doi:10.1007/s12029-012-9423-0.

    CAS  PubMed  CrossRef  Google Scholar 

  22. Telem DA, Sur M, Tabrizian P, Chao TE, Nguyen SQ, Chin EH, et al. Diagnosis of gastrointestinal anastomotic dehiscence after hospital discharge: Impact on patient management and outcome. Surgery. 2010;147(1):127–33. doi:10.1016/j.surg. 2009.06.034.

    PubMed  CrossRef  Google Scholar 

  23. Ohtani H, Tamamori Y, Arimoto Y, Nishiguchi Y, Maeda K, Hirakawa K. A meta-analysis of the short- and long-term results of randomized controlled trials that compared laparoscopy-assisted and open colectomy for colon cancer. J Cancer Educ. 2012;3:49–57. doi:10.7150/jca.3621.

    CrossRef  Google Scholar 

  24. Schwenk W, Haase O, Neudecker J, Muller JM. Short term benefits for laparoscopic colorectal resection. Cochrane Database Syst Rev. 2005;3, CD003145. doi:10.1002/14651858.CD003145.pub2.

    PubMed  Google Scholar 

  25. Figueiredo MN, Maggiori L, Gaujoux S, Couvelard A, Guedj N, Ruszniewski P, et al. Surgery for small-bowel neuroendocrine tumors: Is there any benefit of the laparoscopic approach? Surg Endosc. 2014;28(5):1720–6. doi:10.1007/s00464-013-3381-x.

    PubMed  CrossRef  Google Scholar 

  26. Ihn K, Hyung WJ, Kim HI, An JY, Kim JW, Cheong JH, et al. Treatment results of small intestinal gastrointestinal stromal tumors less than 10 cm in diameter: a comparison between laparoscopy and open surgery. J Gastric Cancer. 2012;12(4):243–8. doi:10.5230/jgc.2012.12.4.243.

    PubMed Central  PubMed  CrossRef  Google Scholar 

  27. Kelly KN, Iannuzzi JC, Rickles AS, Garimella V, Monson JR, Fleming FJ. Laparotomy for small-bowel obstruction: first choice or last resort for adhesiolysis? A laparoscopic approach for small-bowel obstruction reduces 30-day complications. Surg Endosc. 2014;28(1):65–73. doi:10.1007/s00464-013-3162-6.

    PubMed  CrossRef  Google Scholar 

  28. Kim HS, Kim BS, Lee IS, Lee S, Yook JH, Kim BS. Comparison of totally laparoscopic total gastrectomy and open total gastrectomy for gastric cancer. J Laparoendosc Adv Surg Tech A. 2013;23(4):323–31. doi:10.1089/lap.2012.0389.

    PubMed  CrossRef  Google Scholar 

  29. Kaplan M, Salman B, Yilmaz TU, Oguz M. A quality of life comparison of laparoscopic and open approaches in acute appendicitis: a randomised prospective study. Acta Chir Belg. 2009;109(3):356–63.

    CAS  PubMed  Google Scholar 

  30. Kuwabara K, Matsuda S, Fushimi K, Ishikawa KB, Horiguchi H, Fujimori K. Community-based appraisal of laparoscopic abdominal surgery in Japan. J Surg Res. 2011;165(1):e1–13. doi:10.1016/j.jss.2010.09.003.

    PubMed  CrossRef  Google Scholar 

  31. Tsui DK, Tang CN, Ha JP, Li MK. Laparoscopic approach for small bowel tumors. Surg Laparosc Endosc Percutan Tech. 2008;18(6):556–60. doi:10.1097/SLE.0b013e3181889d25.

    PubMed  CrossRef  Google Scholar 

  32. Angenete E, Jacobsson A, Gellerstedt M, Haglind E. Effect of laparoscopy on the risk of small-bowel obstruction: a population-based register study. Arch Surg. 2012;147(4):359–65. doi:10.1001/archsurg.2012.31.

    PubMed  CrossRef  Google Scholar 

Download references

Author information

Authors and Affiliations


Corresponding author

Correspondence to Michael S. Nussbaum M.D., F.A.C.S. .

Editor information

Editors and Affiliations

Electronic Supplementary Material

Below is the link to the electronic supplementary material.

In this video, the surgeon demonstrates his approach to minimally invasive surgical techniques for cancers of the jejunum and ileum. (WMV 57192 kb)

Key Operative Steps

Key Operative Steps

  1. 1.

    Access peritoneal cavity by Veress needle or open (Hasson) approach.

  2. 2.

    Identify the small bowel segment to be resected.

  3. 3.

    Elevate the transverse colon, locate the ligament of Treitz, and run the small bowel.

  4. 4.

    Create a mesenteric window with 5 cm proximal and distal margins.

  5. 5.

    Divide the proximal intestine with a laparoscopic linear stapler.

  6. 6.

    Divide the mesentery with an endoscopic bipolar or ultrasonic energy device.

  7. 7.

    Divide the distal intestine with a laparoscopic linear stapler.

  8. 8.

    Align the two intestinal segments side by side with stay sutures.

  9. 9.

    Create an enterotomy at each end of the intestinal segments.

  10. 10.

    Negotiate the jaws of the linear stapler into the lumen and create a functional end-to-end anastomosis.

  11. 11.

    Close the enterotomy with a linear stapler or with a running suture.

  12. 12.

    Close the mesenteric defect with a running suture.

  13. 13.

    Extract the specimen.

Rights and permissions

Reprints and Permissions

Copyright information

© 2015 Springer Science+Business Media New York

About this chapter

Cite this chapter

Ahmed, B., Weerasinghe, D.H., Nussbaum, M.S. (2015). Minimally Invasive Surgical Techniques for Cancers of the Small Intestine. In: Kim, J., Garcia-Aguilar, J. (eds) Surgery for Cancers of the Gastrointestinal Tract. Springer, New York, NY.

Download citation

  • DOI:

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4939-1892-8

  • Online ISBN: 978-1-4939-1893-5

  • eBook Packages: MedicineMedicine (R0)