Laparoscopic-assisted colonoscopic polypectomy - The Texas Endosurgery Institute experience

PURPOSE: The advent of laparoscopic surgery has altered the manner by which surgical specialties address pathologies of the abdominal cavity. This adv ance in technology has also changed colorectal surgery. One of the more com mon procedures of colorectal surgery is segmental resection for polyps that are large, broad based, or inaccessible for colonoscopic removal. We prese nt a technique combining colonoscopy and laparoscopy to remove troublesome polyps without the need for segmental resections. METHODS: From May 1990 to September 1999 laparoscopic-monitored colonic polypectomies were performed in 47 patients, with a total of 60 polyps being removed. After laparoscopi c mobilization of the involved segment of the colon, the proximal bowel is cross-clamped and the colonoscope passed to the involved portion of the col on. The polyp is then presented to the colonoscopist by the laparoscopist f acilitating removal. The serosal surface is monitored for any indications o f transluminal injury, and the area is repaired if needed. All polyps under go immediate frozen section analysis. If the pathologic evaluation indicate s malignancy then a segmental resection may be performed, otherwise the pat ients are decompressed and fed within a short time before discharge. RESULT S: The polyps were located most commonly in the ascending colon (18 polyps) , transverse colon (12 polyps), and cecum (12 polyps). The most common hist opathologic diagnosis was tubulovillous adenoma in 28 polyps followed by vi llous adenoma in 11 polyps. In three cases histopathologic diagnosis reveal ed malignancy necessitating segmental resection (1 low anterior resection a nd 2 right hemicolectomies), which were performed laparoscopically. Patient s received a liquid diet within 6 hours, were discharged in an average of 2 1 hours, and returned to full activity, usually within days. The only compl ication presented in this group of patients was an umbilical port seroma. V irtually all patients (97 percent) behaved as if only a colonoscopy had bee n performed. Pain at the trocar sites was managed with acetaminophen 600 mg by mouth as needed. CONCLUSION: Laparoscopic-monitored colonoscopic polype ctomy allows patients to undergo removal of colonic polyps without a segmen tal resection. This less invasive procedure yields recovery times similar t o that of colonoscopy alone: and the potential complications of a segmental resection are avoided. All polyps are examined by frozen section, and if a malignancy is encountered, a laparoscopic resection can be performed.