Intraoperative endoscopy in laparoscopic colectomy.
BACKGROUND
The localization of focal colonic pathologies is problematical in laparoscopic surgery because it is difficult to palpate the colon. The aim of this study was to evaluate the use of intraoperative lower endoscopy in laparoscopic segmental colectomy.


METHODS
We did a retrospective review of the charts of patients who had undergone laparoscopic segmental colectomy. Patients in whom intraoperative lower endoscopy had been used were compared to a group of 250 patients who had colectomy by laparotomy. The patients were matched by type of surgery and operating surgeon.


RESULTS
Between 1991 and 2000, 233 patients underwent laparoscopic segmental colectomy at our clinic. Lower endoscopy was employed in 57 of them (24%), as compared to 42 patients (17%) in the laparotomy matched group ( p = 0.042). The diseased segment was successfully identified in all of the patients in whom the main indication for endoscopy was localization (65% of cases). Endoscopy was judged to have changed the surgical management in 66% of the 57 cases in whom it was employed, and especially in 88% of the 37 patients for whom the main indication had been localization. There were no endoscopy-related complications.


CONCLUSIONS
Intraoperative lower endoscopy is a useful and safe tool for the localization of pathologies and the assessment of the intracorporeal anastomosis in laparoscopic segmental colectomy.
Zmora
O
O
Department of Colorectal Surgery, Cleveland Clinic Florida, 3000 West Cypress Creek Road, Fort Lauderdale, FL 33309, USA.
Dinnewitzer
A J
AJ
Pikarsky
A J
AJ
Efron
J E
JE
Weiss
E G
EG
Nogueras
J J
JJ
Wexner
S D
SD
D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods; D003082:Colectomy / Q000379:methods*; D003113:Colonoscopy / Q000379:methods*; D003107:Colorectal Surgery / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012812:Sigmoidoscopy