Anastomotic complications such as leakage and bleeding still represent the most serious complications of laparoscopic colorectal surgery. Intraoperative colonoscopy allows detection of the bleeding source and of leaks. Surgeons have tried testing the anastomosis, especially in the distal colon and rectum by using rectal probes filled with air [25–27] or saline [28–30] or by using methylene blue enema [31]. Adopting intraoperative endoscopy, the pelvis is filled with saline and air is insufflated in the rectum using a sigmoidoscope. The presence of air bubbles indicates anastomotic leaks which can be repaired without delay. In a recent study carried out in 60 patients, intraoperative air testing of colorectal anastomosis proved to be an effective method for prevention of anastomotic dehiscence , incidence being 50 % lower in comparison with the control group [32]. A more novel and recent application of intraoperative endoscopy to evaluate the adequacy of GI anastomoses is based on narrow band imaging (NBI). As vascularization is the primary factor determining anastomotic viability, NBI could prove useful to ascertain tissue vascularity after the anastomotic procedure [33].