ABSTRACT
OBJECTIVE: Endoscopic treatment of large, sessile or awkward localized polyps, especially in the colon sigmoideum or the coecum holds the risk of colonic perforation. For these cases the combined colonoscopic-laparoscopic approach is described in this publication as an alternative procedure. PATIENTS AND METHODS: Since 1995 23 patients (male 11, female 12, age 70.7 +/- 12.0 years) were treated by laparoscopic-assisted colonoscopic polypectomy. Thirteen polyps were localized in the colon descendens or sigmoideum, seven in the cecum and one in the right respectively the left colonic flecture. Under general anesthesia and modified lithotomy position laparoscopy with occlusion of the colon or terminal ileum was followed by colonoscopy. After endoscopic localization the polyp was removed under laparoscopic visualization. During this procedure the colonic wall was stabilized, interfering adhesions were cut and coagulation- induced lesions of the wall were laparoscopically sutured if needed. RESULTS: In 17 patients the endoscopic polypectomy could be performed laparoscopically-assisted. In two patients the polypectomy was done by colotomy and in two others by segmental colonic resection due to the volume of the polyp. In two patients with histologically verified carcinoma laparoscopic-assisted left hemicolectomy was performed secondarily. Intra- or perioperative complications did not occur. CONCLUSION: Laparoscopic-assisted colonoscopic polypectomy is a new minimal-invasive therapeutical approach in selected cases with large, sessile or arkward localized polyps. The endoscopic procedure is possible also in polyps which should be treated by colotomy or segmental resection in the past. The additional discomfort for the patients due to laparoscopy is minimal.
