Dynamic article: combined endoscopic-laparoscopic surgery for complex XXXX : postoperative outcomes and video demonstration of 3 key operative techniques.

@entity1 @entity260 @entity1586 @entity420 @entity1141
BACKGROUND: Combined endoscopic-laparoscopic surgery is a novel technique that can be used to avoid bowel resection for complex @entity1586 that are not amenable to colonoscopic resection. OBJECTIVE: The aim of this study was to evaluate the safety and outcomes of combined endoscopic-laparoscopic surgery for complex @entity1586 . DESIGN: This study is a retrospective review of consecutive combined endoscopic-laparoscopic surgeries. SETTING: This study was conducted at a single institution. @entity1 : All @entity1 that underwent combined endoscopic-laparoscopic surgery for a @entity1586 at our center from October 2009 to October 2013 were followed. Each @entity1 's lesion was assessed by a therapeutic endoscopist before referral for combined endoscopic-laparoscopic surgery, and was deemed unresectable based on size, broad base, or location of the polyp. MAIN OUTCOME MEASURES: Intraoperative and @entity260 , length of hospital stay, and recurrence were the primary outcomes measured. RESULTS: Thirty consecutive @entity1 underwent combined endoscopic-laparoscopic surgery. Twenty (66.7%) @entity1 underwent laparoscopic-assisted colonoscopic polyp excision (10 of these excisions were facilitated by Endoloop placement at the polyp base), 9 (30%) @entity1 underwent colonoscopic-assisted laparoscopic cecectomy, and 1 (3.3%) @entity1 was converted from a colonoscopic-assisted laparoscopic cecectomy to a laparoscopic ileocolic resection. The median length of hospital stay was 2 days (range, 1-16). Twenty-nine (96.7%) of the final pathology results were benign, with 10 (33.3%) showing high-grade @entity1141 . One (3.3%) final pathology result was positive for a well-differentiated @entity420 . This @entity1 subsequently underwent a laparoscopic right hemicolectomy and chemotherapy for node-positive disease. One (3.3%) @entity1 experienced a recurrent benign polyp at the previous excision site, which was removed by colonoscopy. The time to detection of recurrence was 274 days. LIMITATIONS: This study looked at a small group of @entity1 , over a short follow-up period. However, all consecutive @entity1 were captured, and there were no losses to follow-up. CONCLUSIONS: Combined endoscopic-laparoscopic surgery for complex benign @entity1586 is a safe procedure, with good clinical outcomes and low recurrence rates.
