Introduction to Endoluminal Surgery

Jonathan S. Abelson, MD

Endoscopy is a core skill for all graduating colorectal surgery trainees. While this skill set does overlap with the scope of practice of gastroenterology, there are several fundamental differences between gastroenterologists and colorectal surgeons that position us well to care for these patients.

In this issue of Clinics in Colon and Rectal Surgery entitled “Endoluminal Surgery” we cover a broad array of topics that are essential for all colorectal surgeons to know about how to incorporate basic and advanced endoscopic skills into their practice. The issue begins with how to accurately diagnosis and assess colorectal polyps. We then explore a multitude of techniques for how to remove colorectal polyps as well as early-stage colorectal cancers. Colorectal surgeons can approach these lesions purely endoscopically performing endoscopic mucosal resection, endoscopic submucosal dissection, and even using a double-channel endoscope. The benefits of endoscopic management over surgical resection when thoughtfully executed are clearly outlined in these articles.

Since we are more than just endoscopists, colorectal surgeons can also integrate surgical techniques for removal of complex lesions anywhere in the colon and rectum. We can employ combined endoscopic and laparoscopic surgery and transanal minimally invasive surgery (TAMIS) using either a laparoscopic or robotic platform. We also consider how to manage the associated defect, either partial thickness or full thickness, after removing these lesions. For endoscopically obstructing lesions we learn the benefits of, and useful tips and tricks for how to perform endoscopic stenting to avoid the morbidity and mortality associated with emergency surgery.

Beyond learning the actual techniques for how to perform these procedures, we also learn how to train the next generation of endoluminal surgeons as well as how to overcome barriers to implement these tools into one's colorectal surgery practice. Finally, we uncover the future of endoluminal surgery to understand what may be possible when we combine our surgical and endoscopic skill sets.

Our hope is that this issue of Clinics in Colon and Rectal Surgery will grow the community of colorectal surgeons committed to learning and adopting endoluminal surgery to avoid colectomy when possible to improve the care for our patients. These can be complex patients with complex pathology and who better to guide the patient along the pathway from diagnosis to treatment than the colorectal surgeon.

Publication History

Article published online:
17 July 2023