Tissue Apposition System (tas) – New Technology to Minimize Surgery for Endoscopically Unresectable Colonic Polyps

Introduction: This study reports the first clinical series using the TAS device in a feasibility study of endoscopic polypectomy as an alternative to laparoscopic colectomy (LC) for endoscopically unresectable polyps. TAS is a novel T-tag system for endoscopic placement of sutures which facilitates closure of larger defects from advanced endolumenal or translumenal endoscopic procedures. Such novel instrumentation may reduce patient risk and accelerate recovery.
Methods: After IRB approval, patients with endoscopically unresectable polyps who would otherwise require LC were enrolled. The polyp site was visualized by colonoscopy and resected with laparoscopic assistance, if necessary taking some muscularis during endoscopic mucosal resection (EMR) or submucosal dissection. After confirming benign disease by frozen section, the polypectomy site was closed by TAS (Ethicon Endo-Surgery) under laparoscopic control to avoid injury to surrounding structures. Check colonoscopy was done at 3 months.
Results: Seven patients were recruited (five male; mean age 66 years). Polyps were from 20 to 50mm in diameter (mean 30mm), six were in the right colon, and three were on the mesenteric border of the bowel. Final pathology was benign in all cases. Mean EMR time was 29 minutes, mean time taken for TAS was 37 minutes, and mean total operative time was 129 minutes. Two TAS procedures required conversion to LC (one unresectable polyp and one device failure). Five TAS procedures were completed, with a mean hospital stay of 1.2 days, and no complications. Follow-up colonoscopy revealed complete healing in all cases, with no recurrence of polyp to the current time. One patient (initial 5cm sigmoid polyp) had a very mild asymptomatic stricture in the sigmoid colon.
Conclusion: This initial human experience demonstrates that TAS can be used safely in the colon under laparoscopic control. TAS permits safe closure of defects after endoscopic polypectomy of selected and otherwise unresectable polyps, thereby avoiding the need for LC, and permitting rapid recovery with short hospital stay.

Session: Podium Presentation

Program Number: S075

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