Full-thickness laparoendoscopic colonic excision in an experimental model

Background: Patients requiring surgery for complex colonic polyps traditionally undergo colectomy, with significant risks. Typically in excess of 10-30cm of colon is removed at laparoscopic or open surgery lasting over 60min. 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 8days 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 center dot 1 (4 center dot 5-6 center dot 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.