Large colonic or rectal polyps have limited therapeutic options. Formal bowel resection is usually advised unless the polyp is in the low rectum within reach of proctologic instruments. With the assistance of laparoscopy, large polyps that are more proximal may be amenable to colonoscopic polypectomy without bowel resection . This avoids the morbidities that are associated with bowel resections and is especially beneficial in patients who cannot be optimized to tolerate a formal resection. In addition, the use of CO₂ in colonoscopy prevents bowel distension, permitting unimpeded laparascopic surgery.

This video demonstrates such a combined technique. After laparoscopic mobilization, a large, broad-based sigmoid colon polyp is successfully snared through a colonscope using CO₂ insufflation. Any serosal defect is immediately recognized by laparoscopy and repaired. Bowel resection is avoided and the patient is discharged well from hospital within 36 hours, with minimal post-operative morbidity.