New Technique of One-piece Resection to Colorectal Tumor Under Laparoscopy and Endoscopy Co-operatively – Laparoscpy/endoscopy Co-operative Surgery to Colorectal Tumor (LECS-CR)

Yosuke Fukunaga, Yoshiro Tamegai, MD, Akiko Chino, MD, Masashi Ueno, MD, Satoshi Nagayama, MD, Yoshiya Fujimoto, MD, Tsuyoshi Konishi, MD, Takashi Akiyoshi, MD, Toshiki Mukai, Atsushi Ikeda, Toshiya Nagasaki, MD, Jun Nagata, MD

Cancer Institute Hospital

Background and aim: Some colorectal lateral spread tumors are difficult to be resected completely, meaning one-piece, or safely by only endoscopic technique because of various factors. Upon recent drastic development of endoscopic and laparoscopic technique for colorectal lesion, a newly established safe resection procedure approached by both laparoscopic and endoscopic ways (Laparoscopy endoscopy co-operative colorectal surgery; LECS-CR) is described.

Patients: Three colorectal lateral spread tumor patients underwent LECS-CR. The factors affecting endoscopic submucosal dissection (ESD) were submucosal fibrosis because of previous ESD in one and surrounding many diverticles in 2 cases.

Techniques: Patient is placed under general anesthesia and 5 ports are put. Following confirmation of the tumor location by endoscopy and laparoscopy, the colon wall at the lesion is exposed. Firstly in endoscopically, mucosa to submucosa dissection is performed circumferential to the lesion with appropriate safety margin. Complete full thickness dissection is sequentially performed associated with laparoscopic excision by using an ultrasonic activating scissors. The specimen is withdrawn intraluminally. The opened colon is closed in latitude by laparoscopic linear staplers.

Results: The mean operating time and blood loss of this series is 205min and 13g respectively. There are no intraoperative and postoperative complications. Histological examination revealed tubular adenoma with severe dysplasia with sufficient surgical margin in all cases.

Conclusion: LECS-CR may be a feasible procedure for one-piece resection for some colonic lateral spread tumors expected for difficulty of the endoscopic resection with minimum removal of the colon.

Session: Poster Presentation

Program Number: P084

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