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Double transanal laparoscopic resection of large anal canal and low rectum polyps

G Dapri, MD, PhD, FACS, FASMBS, Hon FPALES, Hon SPCMIN, Hon BSS, Hon CBCD, Hon CBC
Epublication WebSurg.com, Feb 2018;18(02). URL: http://websurg.com/doi/vd01en5212

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  • 2018-02-20
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Background: Rectal polyps, and especially small and medium-sized lesions are removed via conventional endoscopy. Large rectal polyps can be approached using endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD). In more recent years, laparoscopic surgery underwent an evolution and a new application for endoluminal resection called transanal minimally invasive surgery (TAMIS) was introduced. The authors report the case of a 79-year-old man presenting with two large polyps of the anal canal (uTisN0) and low rectum (uTis vs T1N0), which were removed through TAMIS. Video: The patient was placed in a prone, jackknife position with legs apart. The reusable transanal D-Port was introduced into the anus. Exploration of the cavity showed the presence of a large polyp involving the entire length of the anal canal and part of the lower third of the rectum and a second large polyp located 1cm above in the lower third of the rectum. The anal canal polyp was removed with the preservation of the muscular layer. The lower third rectal polyp was removed by resecting the full-thickness of the rectal wall. During the entire procedure, the surgeon worked under satisfactory ergonomics. The polyps were removed through the D-Port. The mucosal and submucosal flaps for anal canal resection, as well as the entire rectal wall opening for low rectal resection, were closed by means of two converging absorbable sutures. Results: Operative time was 78 minutes for the anal canal polyp and 53 minutes for the low rectum polyp. Perioperative bleeding was 10cc. The postoperative course was uneventful, and the patient was discharged after 1 day. The pathological report for both polyps showed a tubulovillous adenoma with high-grade dysplasia and free margins (stage: pTis, 8 UICC edition). Conclusions: TAMIS for double and large polyps located in the anal canal and low rectum offers advantages, such as excellent field exposure, safe en bloc polypectomy, and final endoluminal defect closure.