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Minimally Invasive Surgery: Colonoscopic Assisted Transanal Endoscopic Microsurgery for Local Resection of a Large Sigmoid Polyp

Kevin M Izquierdo, MD, Beverly Ng, MD, John H Marks, MD. Lankenau Medical Center

This video demonstrates a novel approach to perform endoluminal surgery for a 3cm polyp in the distal sigmoid colon using a combined rigid and flexible endoscopic approach. The patient is a 56-year-old male who presented with symptoms of intermittent rectal bleeding for several months. He was found to have a large pedunculated polyp at the 19 cm level from the anorectal ring. The polyp was biopsied and pathology demonstrated findings consistent with tubular adenoma without high-grade dysplasia or malignancy. Evaluation by two gastroenterologists, including an advanced, university-based interventionalist, led to referral for a LAR. On our examination by flexible sigmoidoscopy, the lesion was in the distal sigmoid colon, too broad-based to perform a snare polypectomy, and benign in appearance. Morphologically, this represented an ideal lesion for endoscopic resection by TEM. However, its location 10cm proximal to the rectosigmoid, placed it far outside of the reach of the TEM scope. We devised a method using a colonoscope and snare to intussuscept the sigmoid colon into the rectum, and then perform a partial thickness resection and suture repair with the TEM equipment. This video demonstrates this technique. There were no intraoperative complications. The patient was observed for less than 24 hours as a precaution, and he had no post-operative pain. Final pathology showed a tubular adenoma without dysplasia or sign of malignancy. This natural orifice transluminal endoscopic surgical (NOTES) technique demonstrates a novel approach to resect large polyps in the distal sigmoid colon, allowing patients to avoid an abdominal operation.


Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 95240

Program Number: V080

Presentation Session: Exhibit Hall Theater Video Session III

Presentation Type: EHVideo

83

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