Current techniques for combined endoscopic and laparoscopic surgery (CELS)

Surgeons have experienced an increase in the number of patients referred for management of endoscopically unresectable colon polyps as a result of increased adoption of colonoscopy-based cancer screening. The majority of these patients historically received a recommendation to undergo oncologic resection, exposing them to significant operative and long-term morbidity. Combined endoscopic and laparoscopic surgery (CELS) techniques have since been developed to leverage the unique advantages of the two separate approaches to allow colon-sparing resection of complex polyps. CELS techniques have lower complication rates, lower cost, and result in shorter hospitalization and faster patient recovery. CELS techniques include laparoscopic-assisted polypectomy, full-thickness CELS, and colonoscopic-assisted partial cecectomy or wall excision. This article provides an overview of how to perform each technique and discusses the relative advantages and appropriate application of each. Additionally, we discuss new platforms for endoluminal surgical intervention (ELSI), which may be the next advance in colon-preserving management of complex polyps. Utilization of CELS allows surgeons to safely and effectively remove the majority of referred complex colon polyps while sparing their patients the substantial morbidity of colectomy.