New Technique of En Bloc Resection of Colorectal Tumor Using Laparoscopy and Endoscopy Cooperatively (Laparoscopy and Endoscopy Cooperative Surgery - Colorectal)

BACKGROUND AND AIM: Various factors make complete en bloc resection by endoscopic techniques alone of some laterally spreading colorectal tumors difficult or unsafe. Drawing on recent radical developments in endoscopic and laparoscopic techniques for managing colorectal lesions, we aimed to develop a safe resection procedure by using a combination of laparoscopy and endoscopy. We have named this procedure laparoscopic endoscopic cooperative colorectal surgery. PATIENTS: We have performed this procedure on 3patients who had laterally spreading colorectal tumors. The factors contraindicating endoscopic submucosal dissection were submucosal fibrosis because of previous endoscopic mucosal resection in 1 patient and multiple surrounding diverticula in 2 patients. TECHNIQUE: The patient is placed under general anesthesia and 5 ports are inserted. Following confirmation of the tumor location by endoscopy and laparoscopy, the colon wall at this site is exposed. First, a mucosa-to-submucosa dissection circumferential to the lesion with an appropriate safety margin is performed endoscopically. Complete full-thickness dissection and excision is then performed by using ultrasonic activating scissors, endoscopy, and laparoscopy cooperatively. The excised lesion is withdrawn intraluminally with endoscopic forceps. The opened colon is then closed with laparoscopic linear staplers. RESULTS: The mean operating time and blood loss in this series were 205 minutes and 13 mL. There were no intraoperative or postoperative complications. Histological examination revealed tubular adenomas with severe dysplasia and adequate surgical margins in all cases. CONCLUSION: Laparoscopic endoscopic cooperative colorectal surgery involves removal of a minimal length of colon and is a feasible procedure for en bloc resection of some colonic lateral spreading tumors that would be difficult to resect endoscopically.