Transabdominal, Transcolonic Polypectomies in a Porcine Model: Avoiding Unnecessary Bowel Resections with the Use of the Minilap Device

Donald M Davis, MD, James JL Mateka, Jorge E Marcet, MD. University of South Florida

Introduction: Many benign colorectal polyps cannot be positioned correctly or reached by the endoscope for polypectomy. Accordingly, patients undergo surgical resection of involved bowel. Due to this fact, we have attempted to develop minimally invasive techniques in porcine models to assist with endoscopic polypectomies. The Minilap is a novel device that deploys a grasping mechanism through a needle-tipped shaft. We have used this device for dissection, exposure, retraction, as well as transcolonic insertion to assist in this endeavor.

Methods: Using a supine porcine model, two 12mm ports are placed (periumbilical and right lower quandrant) for a camera and instrumentation. Minilaps are inserted to assist with exposing, retracting, and dissecting. Once the area of polypectomy is exposed, the minilap is inserted (using the needle tip)transcolonically to present the polyp to the endoscope. After polypectomy, the colotomy is closed with a purse string and instruments are removed.

Results: We have been able to simulate endoscopic polypectomies with transcolonic assistance from the Minilap for polyps that would normally be inaccessible. Intracolonically, the Minlap can be placed through a loop cautery and used to grasp the polyp. The loop then slides over the device to the base of the polyp. Another technique uses the Minilap to grasp proximal mucosa and display the polyp; making it accessible to the endoscope.

Conclusion: In the porcine model, the Minilap can be used to assist endoscopic removal of difficult to reach polyps. This will hopefully translate into decreased bowel resections, morbidity and hospital stay in human subjects.

Session: Emerging Technology
Program Number: ET012

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