Paul R O’Mahoney, MD, Tushar Samdani, MD, Sang W Lee, MD, Jeffrey W Milsom, MD. Weill Cornell Medical College-NewYork Presbyterian Hospital
Large right colon polyps can be difficult to manage endoscopically and patients often require colectomy for removal. However, avoidance of colectomy in large right colon polyps can improve patient outcomes. Combined endoscopic laparoscopic surgery (CELS) is a technique to avoid colectomy by simultaneously utilizing endoscopy and laparoscopy for polyp removal. Laparoscopic colon mobilization, colon tenting/stretching and colonic invagination are techniques that can help position difficult right-sided polyps for endoscopic mucosal resection under CO2 colonoscopy. The use of argon beam coagulation and tattooing has also been found to be useful. In addition, laparoscopic seromuscular suture repair can be readily performed if necessary. These essential techniques allow CELS to be a good option for difficult right colon polyp removal and result in reduced morbidity, length of hospital stay and cost.