Utility and techniques of intraoperative endoscopy and interventions

Intraoperative endoscopy is an indispensable tool for gastrointestinal surgery. Advent of CO2 endoscopy has allowed for incremental expansion of its applications. With experienced endoscopist surgeon and operating room staffs, intraoperative endoscopy can be done without added morbidity in time-efficient manner, while providing value in diagnosis and treatment. Intraoperative endoscopy has long been used to localize small tumor when palpation and preoperative endoscopic tattoo do not clarify the precise location of the tumor. It can be used to ascertain distal transection point in rectum, to assess integrity and perfusion of pelvic anastomosis, to aid in laparoscopic sleeve cecectomy or combined endo-laparoscopic surgery (CELS), and to localize small intestine bleeding. Intraoperative endoscopy is invaluable in the case of anastomotic leak and bleeding. Utility of intraoperative endoscopy is expected to grow as new device and platform become available.