ENABLING PLATFORMS THAT FACILITATE ENDOLUMINAL SURGERY: WHERE ARE WE HEADED?
Ilker Ozgur, David Liska, Amy L. Lightner, Scott Steele, Emre Gorgun*
Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH
Background
Tens of thousands of benign colorectal polyps are removed via colectomy in the US yearly. To help lower the morbidity, mortality and improve quality of life associated with therapy, there has been increasing interest, recognition, and adoption of endoluminal surgery worldwide. However, technical challenges remain and have been an impetus for developing new devices to facilitate advanced endoscopic procedures. An endoluminal surgical platform (ESP, Lumendi, LLC, USA) was developed to expedite therapy through endoscopic stabilization and tissue manipulation. We report on initial outcomes with the use of this platform for endoluminal surgery.
Methods
We analyzed data of consecutive patients who underwent advanced endoscopic resection for colorectal polyps with the ESP between June 2019 and August 2021. The ESP consists of an over-tube like sheath that fits over any standard endoscope with two balloons that can be manually inflated/deflated to provide endoscope stabilization and two external tool channels that can be used as a conduit for passage of an ESP flexible grasper (Ig) to lift and manipulate tissue. Data collected included patient demographics, polyp characteristics, and short-term outcomes.
Results
The study included 33 procedures. The median age of patients was 65 (range: 42-80) years with a mean body mass index of 28 kg/m2, and 66% (n=22) were female. The median lesion size was 51 (range: 20-120) mm, and 54% (n=18) of lesions were distal to the splenic flexure. The dissections were en-bloc in 70% (n=23) of procedures and piecemeal in 15% (n=5). There were 5 (15%) incomplete resections requiring conversion of procedure type. Conversion to laparoscopy was due to submucosal invasion (n=2) and looping of the colon (n=1) in 3 cases. Two procedures were converted to TAMIS for rectal wall defect repair (n=2). Five (15%) patients had immediate perforations, which were managed with over-the-scope-clip (n=2), TAMIS (n=2), and one patient underwent segmental resection (n=1) due to perforation and coexisting invasion. We observed only late bleeding as late complications in 3(9%) patients. They were all re-admitted and observed. Pathology revealed 15(45 %) tubular adenoma, 14(43 %) tubulovillous adenoma, one (3 %) sessile serrated lesion, and three (9%) adenocarcinomas (pT1). Excluding the adenocarcinoma patients who required surgery, the platform facilitated organ preservation in 90%(27/30) of cases, and there was no recurrence during the median follow-up of 11 months (range: 6-19 months).
Conclusions
Endoluminal surgery with the DiLumen platform and grasper is safe and feasible. The flexible platform may serve as a foundation for future innovations in endoluminal surgery.
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