Laparoscopic-assisted colonoscopic polypectomy works as well as standard laparoscopic hemicolectomy to remove difficult to reach polyps in the right colon, with fewer complications and shorter hospital stays, according to data from a recent trial.
Instead of taking out a section of the ascending colon to remove the polyp, a surgeon uses a laparoscope to mobilize and position the right colon during laparoscopic-assisted colonoscopic polypectomy (LACP) so that an endoscopist can reach, snare, and remove it.
The team randomized 14 patients to LACP and 14 to laparoscopic hemicolectomy (LHC). The LACP group had shorter mean operating times (95 vs. 179 min.), less blood loss (13 vs. 63 mL), and required less intravenous fluid (2.1 vs. 3.1 L). LACP patients were also quicker to pass flatus (1.44 vs. 2.88 days), resume solid food (1.69 vs. 3.94 days), and leave the hospital (2.63 vs. 4.94 days), all statistically significant differences.
One LACP patient required conversion to LHC, while four LHC patients required conversion to laparotomy. There were no significant between-group differences in postoperative complications, readmissions, or second operations.
"That ability to remove polyps with LACP was as effective and safe as the standard laparoscopic hemicolectomy ... and patients were discharged from the hospital earlier. We think this is a very exciting change in how we deal with these difficult to remove colon polyps," said Dr. Jonathan Buscaglia, director of advanced endoscopy at Stony Brook (N.Y.) University.
There are a few case series in the literature about the technique, but uptake seems to have been slow so far. "I think the biggest roadblock is the ability of a surgeon to coordinate with a gastroenterologist. You need good working relationships, and schedules able to accommodate [both]. That’s not always easy, depending on where one works," Dr. Buscaglia said at a teleconference in advance of the annual Digestive Disease Week.
The patients in the trial had benign polyps with lift signs and generally tubular or tubulovillous adenomas. The groups were evenly matched for age, sex, body mass index, American Society of Anesthesiologists physical status, and previous abdominal surgery, plus polyp morphology, location, size, and histology.
It’s too soon after the procedures for serial surveillance colonoscopies and to know if any of the patients went on to develop cancer after their operations.
The right side is technically an easier place for laparoscopic surgeons to operate; with the left colon, operators have to worry more about diverticulitis, scarring, and tight anatomy. Even so, LACP may still be useful. "We are looking forward to conducting" a larger, possibly multicenter study on its application to polyps "in all areas of the colon," Dr. Buscaglia said.
The investigators have no disclosures.
