Oral Full Papers

Abstract

The number of patients with endoscopically irresectable colonic polyps or Stage I cancer is increasing due to the introduction of bowel cancer screening programs. These patients usually undergo hemicolectomy when localised full thickness excision would be adequate. To address this and improve clinical outcomes, we have further developed a previously reported full thickness laparo-endoscopic excision (FLEX) technique. Methods: Following a series of ex-vivo experiments to standardise procedural steps, the procedure was performed in five 70-kg pigs. A simulated colonic polyp was created by endoscopic ink injection and a clearance margin was delineated by circumferential placement of mucosal argon plasma coagulator (APC) marks. Full thickness eversion of the bowel wall was achieved using endoscopically placed BraceBars and the 'pseudopolyp' was excised using a laparoscopic stapler. The first pig was terminated immediately thereafter; the others were sacrificed 8 days after surgery. Results: The median procedure duration from placement of mucosal APC marks to specimen excision was 26 min (range 20-31 min). Excised specimens had a median diameter of 51 cm (range 45-63 cm). Postoperative recovery in survival animals was uneventful. Post-mortem and histological evaluation demonstrated well-healed resection sites with no evidence of intra-abdominal infection or inadvertent organ damage. Endoscopic evaluation of anastomoses at post-mortem demonstrated a patent lumen in all animals with no evidence of stenosis. Histological examination showed a primary closure by mucosal abbutal and regeneration, with repair and restoration of continuity of the submucosa at anastomotic sites. Conclusions: This is the first full thickness resection technique described to date suitable for translational to clinical practice, as an alternative to hemicolectomy. The ability to preserve mesenteric vasculature and colonic length is likely to result in less morbidity and mortality, better functional outcomes and reduced treatment costs.

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