Laparoscopic local excision of a proximal rectal carcinoid.

Early carcinoids of the distal rectum have been treated effectively by transanal local excision. Unfortunately, small carcinoids of the proximal rectum may be unreachable by transanal approaches, and as a result patients have been subjected to more extensive, transabdominal colorectal resections. The recent introduction of minimally invasive techniques for treatment of colorectal diseases has opened new approaches for the treatment of proximal rectal carcinoids. We describe a patient with a 0.5 cm rectal carcinoid located just above the peritoneal reflection in whom transanal local excision was not feasible. We report the first laparoscopic, full-thickness excision of a proximal rectal carcinoid. Intraoperative colonoscopy was used to localize the lesion. This combined laparoscopic and colonoscopic approach spared the patient from the potential morbidity of a low anterior resection and anastomosis.