Current roles of colonoscopy in minimally invasive colorectal surgery: Preoperative guidance, intraoperative colonoscopy, and combined endoscopic-laparoscopic surgery

Abstract

Colonoscopy is a cornerstone in the detection and diagnosis of colorectal tumors, playing a critical role in both screening and clinical evaluation. More recently, its utility has expanded to therapeutic guidance, particularly with the advent of minimally invasive surgical techniques. Preoperative tattoo marking is commonly used for tumor localization; however, it poses challenges such as intraperitoneal ink scattering and difficulty in defining dissection planes in the lower rectum. To address these limitations, a new technology utilizing a near-infrared fluorescence clip placed preoperatively enables accurate intraoperative tumor localization. Intraoperative colonoscopy offers additional advantages, including real-time tumor localization, colonic irrigation, visualization of the proximal colon in obstructive cases, and assessment of anastomosis following colorectal resection. Notably, intraoperative colonoscopy allows for the immediate detection and management of complications, such as anastomotic bleeding and leakage, potentially improving postoperative outcomes. Furthermore, advances in endoscopic resections, including endoscopic mucosal resection, endoscopic submucosal dissection, hybrid endoscopic submucosal dissection, and combined endoscopic laparoscopic surgery, have broadened the indications for endoscopic and endoscopy-guided full-thickness resection of colorectal tumors. These approaches are increasingly applicable beyond conventional colorectal neoplasms and show promise in managing appendiceal tumors as well.

Keywords: Intraoperative colonoscopy; Tumor localization; Anastomotic integrity; Synchronous lesion; Endoscopic mucosal resection; Endoscopic submucosal dissection; Combined endoscopic laparoscopic surgery; Laparoscopy and endoscopy cooperative surgery for colorectal tumors; Near-infrared florescence clips

Core Tip: Colonoscopy has evolved beyond diagnostics to serve as a valuable tool for therapeutic guidance in minimally invasive colorectal surgeries. Traditional preoperative tattoo marking for tumor localization carries risks, including ink scattering and challenges in dissecting the lower rectum. Near-infrared fluorescence clips, placed preoperatively, offer improved intraoperative tumor localization. Intraoperative colonoscopy enables real-time tumor identification, colonic irrigation, and assessment of anastomotic integrity, potentially reducing the risk of leakage. Advanced endoscopic techniques, including endoscopic mucosal resection, endoscopic submucosal dissection, hybrid endoscopic submucosal dissection, and combined endoscopic laparoscopic surgery, have broadened the options for resecting colorectal tumors and appendiceal neoplasms, supporting endoscopy-guided full-thickness resection.