Asian Journal of Case Reports in Surgery

Our Initial Experience with Combined Endo-Laparoscopic Surgery (CELS) for Removal of a Large Benign Colonic Polyp

Amanda Huimin See *

Department of General Surgery, Changi General Hospital, Singapore.

Ong Jianming Calvin

Department of General Surgery, Changi General Hospital, Singapore.

S. Yusof

Department of General Surgery, Changi General Hospital, Singapore.

R. Wijaya

Department of General Surgery, Changi General Hospital, Singapore.

*Author to whom correspondence should be addressed.

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Abstract

Large benign-looking polyps that are not amenable to endoscopic polypectomy may require bowel resection for removal. Although laparoscopic resection of bowel has improved short term outcomes in patients, there are still risks associated with bowel resection. A combined approach using both endoscopy and laparoscopy in carefully selected patients with large benign polyps not amenable to endoscopic removal have been described to as an alternative. Studies have shown that both short term and long term outcomes are safe and effective as a technique to remove such polyps.

We present a case report of our initial experience with this technique, a summary of patient’s selection for this technique as well as a review of the outcomes of this technique from available evidence.

Keywords: Combined endo-laparoscopic surgery, laparoscopy, benign polyps, polypectomy

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References

Beck DE, Karulf RE. Laparoscopic-assisted full-thickness endoscopic polypectomy. Dis Colon Rectum. 1993;36:693-5.

Erik R. Noren, Carey Wickham, Sang W. Lee. Current techniques for combined endoscopic and laparoscopic surgery (CELS). Annals of Laparoscopic and Endoscopic Surgery. 2019;4:77.

Dirk W, Stefan Von D, Lars W, et al. Combined laparoscopic-endoscopic resections of colorectal polyps: 10 year experience and follow-up. Surg Endosc. 2009;23:688-693.

Sharma S, Xing J, Nakajima K, et al. Combined endo-laparoscopic surgery is significantly less costly than traditional surgery. J AM Coll Surg. 2015;221:S29.

Jayaram A, Barr N, Plummer R, et al. Combined endo-laparoscopic surgery (CELS) for benign colon polyps: a single institution cost analysis. Surg Endosc; 2018.

Kelly A Garrett, Sang W Lee. Combined Endoscopic and laparoscopic surgery. Clin Colon Rectal Surg. 2015;28:140-145

Nakajima K, Lee SW, Sonada T, Milsom JW. Intra-operative carbon dioxide colonoscopy: A safe insufflation alternative for locating colonic lesions during laparoscopic surgery. Surg Endosc. 2005; 19:321-325.

Yan J, Trecheva K, Lee SW et al. Treatment for right colon polyps not removable using standard colonoscopy; combined laparoscopic-colonoscopic approach. Dis Colon Rectum. 2011;54: 753-8.

Franklin ME Jr, Leyva-Alvizo A, Abrego-Medina, et al. Laparoscopically monitored colonoscopic polypectomy: am established form of endoluminal therapy for colonic polyps. Surg Endosc. 2007;21: 1650-1653.

Franklin ME, Portillo G. Laparoscopic monitored colonoscopy polypectomy; long-term follow up. World J Surg. 2009;33(6): 1306-1309.

Montserrat Guraieb-Trueba, Victor Manuel Rivera-Mendez, Juan Carlos Sanchez-Robles. Combined endoscopic-robotic resection of a giant polyp to avoid colorectal resection. CRSLS. 2021;8(1): e2022.00097.