• A Brigic, A Southgate, P Sibbons, S K Clark, C Fraser, and R H Kennedy.
• Department of Surgery and; Wolfson Unit for Endoscopy, St Mark's Hospital and Academic Institute.
• Br J Surg. 2013 Nov 1;100(12):1649-54.

BackgroundPatients 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.MethodsBoth 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.ResultsFive 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.ConclusionFull-thickness localized colonic excision with this technique provides a large specimen with adequate healing in a porcine model.© 2013 British Journal of Surgery Society Ltd. Published by John Wiley & Sons Ltd.

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