Intraoperative CO₂ colonoscopy is an emerging technology with many potential applications in the surgical management of colorectal patients. CO₂ is used as the insufflating gas rather than room air, and because it is absorbed 150x faster, significant bowel distention is avoided. Because of this property, CO₂ colonoscopy can be used concurrently with open or laparoscopic procedures, allowing for surgical treatment that is enhanced by a simultaneous evaluation of the colonic lumen.

This video illustrates a potential use for combined laparoscopy and CO₂ colonoscopy to treat an iatrogenic colonic perforation. In this case, following identification of the perforation, mobilization of the sigmoid colon, and laparoscopic suture repair, intra-operative CO₂ colonoscopy is performed to inspect the colonic lumen and to perform a leak test with saline immersion.

Combined laparoscopy and CO₂ colonoscopy is safe and may have a useful role in iatrogenic colonic perforation.