COMBINED ENDOSCOPIC ROBOTIC SURGERY FOR COMPLEX COLON POLYPS: A RETROSPECTIVE STUDY

ABSTRACT

Purpose/Background: Combined endoscopic robotic surgery (CERS) is a novel surgical technique that modifies traditional endoscopic laparoscopic surgery with robotic assistance to aid in removal of complex colonic polyps. Hypothesis/Aim: This study aimed to evaluate the safety and outcomes of combined endoscopic robotic surgery. Methods/Interventions: A retrospective review of a prospective database was conducted. Patients underwent CERS by a single colorectal surgeon from March 2018 to October 2021. Polyps were initially found by a referring gastroenterologist and deemed unresectable by traditional endoscopy. Complex polyps were identified in the colon endoscopically while the da Vinci Xi robot was utilized to aid in polyp resection. Once complete, the resection site was over-sewn with absorbable Lembert sutures under endoscopic supervision. Based on pathology, patients were instructed to undergo repeat colonoscopy 3 to 12 months from their operative date. Results/Outcome(s) Combined endoscopic and robotic surgery was successfully completed in 85 of 93 (91%) cases. Patients were converted to other procedures due to discovery of a smaller polyp than anticipated, concern for malignancy, involvement of the ileocecal valve, inability to lift the polyp, or involvement of the appendiceal stump. Among the 85 participants seeing CERS to completion, average age was 66 years (SD=10), body mass index was 29 (SD=6), and history of abdominal surgeries was 1 (SD=1). Median operative time and polyp size were 73 mins (range 31-184 mins) and 40 mm (range 5-180 mm), respectively. Most common polyp locations were cecum, ascending, and transverse colon (29%, 29%, 24%). Pathology mainly demonstrated tubular adenoma (76%). To date, 40 patients underwent follow-up colonoscopy, with an average follow-up time of 7 months (range 3-22 months). Of those, one patient (2.5%) had resection site polyp recurrence. Limitations: Limitations for our study include lack of randomization and follow-up rate to assess for recurrence. The low compliance rate may be due to patient reluctance to get a colonoscopy or procedure cancelations/ difficulty scheduling due to changing COVID-19 regulations. Conclusions/Discussion: Most recent literature reports median operative times for combined endoscopic laparoscopic surgery (CELS) as 85 mins (range 50-225 mins) and 135 mins (range 120-170 mins). Resection site polyp recurrence for traditional endoscopic mucosal resection and CELS ranges from 13.1% and 3.3-10%, respectively. Our findings suggest that CERS is associated with decreased operating time and resection site polyp recurrence. Overall, CERS is a practical technique that enhances current methods for the resection of complex colonic polyps.