Traditionally, patients with
colonic polyps not amenable to endoscopic removal require open
colectomy for management. We evaluated our experience with minimally invasive approaches including endoscopic mucosal resection (EMR), laparoscopic-assisted endoscopic polypectomy (LAEP), and laparoscopic-assisted
colectomy (LAC). Patients referred for surgery for
colonic polyps were selected for one of three minimally invasive modalities. A total of 123 patients were referred for resection of "difficult"
polyps. Thirty underwent EMR, 25 underwent LAEP, and 68 underwent LAC. Of those selected to undergo EMR or LAEP, 76.4% were successfully managed without colon resection. The remaining 23.6% underwent LAC. Nine complications were encountered, including two requiring reoperative intervention. Of the 123 patients, three were found to have malignant disease on final pathology. Surgical resection can be avoided in a significant number of patients with "difficult"
polyps referred for surgery by performing EMR and LAEP. In those who require
surgery, minimally invasive resection can be achieved.