Full-thickness laparoendoscopic colonic excision in an experimental model

Abstract

Abstract Background Patients requiring surgery for complex colonic polyps traditionally undergo colectomy, with significant risks. Typically in excess of 10–30 cm of colon is removed at laparoscopic or open surgery lasting over 60 min. This study details the preclinical development of a rapid, minimally invasive, limited full-thickness colonic resection. Methods Both survival and non-survival procedures were performed in anaesthetized 70-kg pigs. A simulated colonic polyp was created by endoscopic ink injection with a clearance margin delineated by circumferential placement of mucosal argon plasma coagulation marks. Full-thickness eversion of the bowel was achieved using endoscopically placed anchors and the polyp was excised using a laparoscopic stapler. In survival procedures, pigs were killed under anaesthetic 8 days after surgery. All pigs underwent post-mortem examination. Results Five procedures were performed (5 pigs). The median (range) procedure duration was 26 (20–31) min, with a specimen diameter of 5·1 (4·5–6·3) cm. The postoperative recovery of survival animals (4 pigs) was uneventful. At post-mortem evaluation the resection sites were well healed with no evidence of stenosis, intra-abdominal infection or inadvertent organ damage. Histological assessment of anastomoses showed mucosal repair and restoration of submucosal continuity. Conclusion Full-thickness localized colonic excision with this technique provides a large specimen with adequate healing in a porcine model. Presented to the Annual Meeting of the Association of Surgeons of Great Britain and Ireland, Glasgow, UK, May 2013; published in abstract form as Br J Surg 2013; 100(Suppl 7): 2