Introduction Current surgical/trans-anal and endoscopic techniques for resection of very large (>5 cm)/complex rectal polyps (CRP’s) remain problematic due to technical complexity, inadequate excision and safety issues.
Method Four patients with complex benign rectal polyps, two circumferential lesions and two with severe submucosal scarring due to multiple previous resection attempts were resected utilising the TASER approach. Prior to referral, all patients were being considered for proctectomy due to failed conventional endoscopic therapy. Trans-Anal-Submucosal-Endoscopic-Resection (TASER) involves placing the Gelport-Path platform across the anus to facilitate three air-tight rectal access ports. An endoscope through one port was then used to provide vision, gas insufflation and carry resection knives, snares and haemostatic devices while the two remaining ports were used for laparoscopic retractors, suturing or cutting devices. The purpose of this case series is to demonstrate the feasibility of this new hybrid, endo-surgery approach.
Results Four TASER procedures were employed in 4 patients (mean age 63 years, 2 males/2 females) with 4 CRPs (mean size 75 mm/range, 50–130 mm). Complete excision was achieved in all polyps. Mean procedure time was 185 min/range, 65–480 min. TASER-aided resection was performed utilising Endoscopic Submucosal Dissection/ESD in 1/4, ESD+Piecemeal-Endoscopic-Mucosal-Resection/P-EMR in 2/4 and ESD + Trans-Anal-Minimally Invasive Surgery/TAMIS in 1/4. In the two cases of severe submucosal fibrosis, dissection resulted in small full-thickness, extra-peritoneal defects that were easily repaired with suturing and clips. No episodes of bacteremia or delayed bleeding occurred. All patients had an uneventful recovery and were discharged within 24 hrs. First follow up colonoscopy showed slight luminal narrowing without structuring and no recurrence in 2 patients and first follow up is pending in the other two cases.
Conclusion TASER appears to be a safe and effective endo-surgical approach providing a flexible platform for the minimally-invasive management of extensive/recurrent rectal polyps, previously destined for surgery.
Disclosure of interest None Declared.
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