3 The procedure
3.1 Combined endoscopic and laparoscopic removal of colonic polyps is used to excise polyps that are unsuitable or high‑risk for endoscopic removal, without the need for open surgery or segmental laparoscopic resection. The procedure aims to provide enhanced visualisation and enable the colon to be manoeuvred and controlled during resection of the polyp.
3.2 The procedure is done with the patient under general anaesthesia. The position of the polyp is noted by making intraluminal and extraluminal marks around the polyp using endoscopic coagulation and laparoscopic diathermy respectively. Alternatively, the location of the polyp can be marked using endoscopic tattooing. Sutures are placed laparoscopically (extraluminally) at the marked sites around the polyp. The sutures are then drawn together to invert a fold, containing the polyp, into the colonic lumen. The inversion site is then laparoscopically oversewn and the protruding tissue, including the polyp, is removed endoscopically. Alternatively, a wedge excision of the marked polyp is done laparoscopically and the polyp retrieved and removed from one of the laparoscopic port sites. It is then sent for histopathological examination.