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Laparascopic-assisted endoscopic mucosal resection of a polyp in sigma and laparoscopic right hemicolectomy for adenocarcinoma in colon ascendens - case report

Ivan Lyutakov, Plamen Penchev, Branimir Golemanov, Georgi Jelev, Emil Kostadinov, Ivan Terziev, Borislav Vladimirov


Today, endoscopic polypectomy has become a daily-performed routine procedure in the operating room. Almost every polyp in the colon can be removed endoscopically, but there are some problematic adenomas which are either large in size or difficult to approach. We present 80 years old white woman with a tubulo­villous adenoma with high-grade dysplasia on a flat surface located in sigma with 4 x 5cm in size and also synchronously found in colon ascendens a well differentiated G1 adenocarcinoma with 2 x 2cm in size on a flat surface. The abdominal ultrasound did not find any liver metastases. Because of the difficult location and the size of the two lesions in the right and left colon, we make a decision for a laparoscopic-assisted en­doscopic mucosal resection (piece-meal) of the polyp in sigma and for the adenocarcinoma in colon ascen­dens the procedure was followed by laparoscopic right hemicolectomy in one step approach. The both inter­ventions were performed without complications and good postoperative period. Hybrid endoscopic and lap­aroscopic interventions are very effective approach that can resect large tubulovillous polyps and adenocar­cinoma of the colon, with a lesser risk of complications. Combining the methods in one surgery save time, make endoscopy more easy to perform and can save one-half of the colon in cases of synchronous lesions of the colon. Scr Sci Med 2017; 49(3): 49-52


Endoscopic mucosal resection, Laparoscopic surgery, Polypectomy, Tubulovillous adenoma, Colon adenocarcinoma

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About The Authors

Ivan Lyutakov

Plamen Penchev

Branimir Golemanov

Georgi Jelev

Emil Kostadinov

Ivan Terziev

Borislav Vladimirov

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