Introduction Polypectomy during colonoscopy can be challenging and is potentially dangerous. Patients with particularly challenging polyps have been traditionally referred for segmental colectomy.
Laparo-endoscopic resection (LER) has been found to be safe and effective in other centres1,2. Laparascopic mobilisation of the colon for endoscopic sub-mucosal resection (EMR) has the potential to assist with the removal of complex polyps and can allow immediate management of complications.
We implemented a pathway for patients who would previously have been offered segmental resection to undergo colonoscopy in theatre under general anaesthetic (GA) by an expert colonoscopist with a laparoscopic colorectal surgeon present to assist with laparoscopic mobilisation or proceed to segmental colectomy if required.
Our aim was to assess the safety and feasibility of this new service and to compare our results to published data.
Methods Cases were collected prospectively from February 2010 to September 2012.
Data on patient demographics, indication, lesion site and size, index colonoscopist, LER surgeon and endoscopist, procedural details, length of hospital stay, completeness of endoscopic resection and complications were collected retrospectively by two independent investigators.
Results 25 patients, (17 male) underwent GA colonoscopy in theatre for 26 polyps. Polyp size estimation at initial colonoscopy ranged from 10–50mm, median 25mm. 15 polyps were in the right colon.
8 (32%) required segmental colectomy: 5 lesions appeared malignant, 1 was too large, 1 and 2 technically impossible to resect. 2 cases required laparoscopic mobilisation of the colon to aid EMR.
15 patients (60%) avoided any abdominal surgical intervention.
Median length of hospital stay was 1 day.
2 patients had significant post-operative bleeding (1 EMR, 1 port-site). 1 patient developed a collection after laparoscopic resection which required radiological drainage. 1 EMR patient had polyp cancer with inadequate resection margins and required subsequent laparoscopic resection.
Conclusion Although the number of patients is relatively small, the pathway is a safe and feasible way to reduce the need for colonic resection for complex polyps. A significant number of patients avoided the need for segmental resection, and most did not require any laparoscopic assistance.
Disclosure of Interest None Declared
Franklin, M.E., Jr., et al. Laparoscopically monitored colonoscopic polypectomy: an established form of endoluminal therapy for colorectal polyps. Surgical endoscopy 21, 1650–1653 (2007).
Wood, J.J., Lord, A.C., Wheeler, J.M. & Borley, N.R. Laparo-endoscopic resection for extensive and inaccessible colorectal polyps: a feasible and safe procedure. Annals of the Royal College of Surgeons of England 93, 241–245 (2011).