This video demonstrates the technique of laparoscopic-assisted endoscopic polypectomy in a 56 year old man who was referred by his gastroenterologist. This method of intraoperative colonoscopy and polypectomy with the addition of laparoscopic assistance if needed can spare patients with difficult benign polyps the need for segmental resection.

Under general anesthesia the patient is positioned in low lithotomy and laparoscopic access achieved with three 5 mm ports. The involved portion of the colon is then mobilized in preparation for the colonoscopy. A non-crushing bowel clamp is placed across the bowel proximal to the polyp to limit colonic insufflation. The colonoscope is then introduced and the laparoscopic surgeon presents the polyp to the colonoscopic surgeon as needed. A submucosal injection of epinephrine (1:200,000) is used to raise the polyp for resection and aid in vasoconstriction. The polyp is then excised using the snare electrocautery while laparoscopically monitoring the serosal surface of the bowel for thermal injury or perforation. Electrocautery is then also applied as needed to the base of the polyp where excision may have been incomplete. Should transmural injury of the bowel occur, it may be repaired laparoscopically using absorbable Lembert sutures.

The patient did well postoperatively and was discharged home on the same day tolerating a regular diet. Pathology demonstrated a tubular adenoma.

We have demonstrated the technique of laparoscopic-assisted endoscopic polypectomy and conclude it is an effective way to avoid bowel resection in patients with difficult but benign polyps.