Michael E Dolberg, MD, FACS, FASCRS. Memorial Healthcare System
Purpose: This video presents a case of a 46 year old female with a history of chronic left sided abdominal pain. A thorough evaluation was performed which included a colonoscopy. This exam revealed a large submucosal mass in the proximal descending colon with associated mucosal ulceration. A CT scan confirmed the presence of a 6 cm fat containing mass just distal to the splenic flexure without evidence of colonic obstruction. The patient was taken to the operating room for a Colonoscopic Assisted Robotic Resection (CARR) of the submucosal mass.
Methods: The patient received a full bowel preparation. The procedure was performed in the lithotomy position to allow for intra-operative colonoscopy. The abdomen was entered in the right upper quadrant with an 8 mm optical robotic port. Colonoscopy was performed which confirmed the presence of the submucosal mass in the proximal descending colon. This lesion was located at the anti-mesenteric border of the colon. The area was marked with clips. Four additional ports were placed along the right side of the abdomen. These ports included two additional 8 mm ports, a 12 mm port, and a 5 mm assistant port. Using cautery, a full thickness local resection of the mass was performed, including the involved ulcerated mucosa. The defect was then closed transversely using multiple firings with the robotic stapler.
Results: The patient was successfully treated with this robotic/endoscopic technique. She was tolerating a regular diet and passing flatus on POD 1. She was ready for discharge on POD 2. The patient was seen in the office 2 weeks following the procedure. Her chronic abdominal pain had completely resolved. The final pathology showed colonic tissue with a submucosal lipoma with areas of fat necrosis, overlying mucosal ulceration, and reactive changes.
Conclusions: Colonoscopic Assisted Robotic Resection (CARR) is a technique that can be used to remove benign masses from the colon without the need for a formal resection. The use of the colonoscope allows definitive localization of the lesion so that the colotomy can be made in the appropriate position. Review of this case did allow the authors to make recommendations for future use of the technique. Although hook cautery was used in this procedure, a scissor may have offered increased accuracy and less thermal spread. The colotomy was closed with the stapler in this resection. Primary sutured closure would likely have been easier, faster, and less expensive.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95656
Program Number: V258
Presentation Session: Video Loop Day 2
Presentation Type: VideoLoop