title: Laparoscopic-facilitated endoscopic submucosal dissection, mucosal resection, and partial circumferential ("wedge") colon wall resection for benign colorectal neoplasms that come to surgery.
abstract: BACKGROUND
  Large polyps that come to surgery are removed via colectomy (CR). Alternatives are MIS-facilitated endoscopic submucosal dissection/endoscopic mucosal resection (ESD/EMR) or wedge resection (WR). This study presents the results of 26 polyp patients who had minimally invasive surgery (MIS)-monitored ESD/EMR, WR, or if necessary, standard CR.
  
  
  METHODS
  The authors used a retrospective review of 1 surgeon's experience. ESD/EMR was the first choice, WR was the second, and CR was the last resort.
  
  
  RESULTS
  Polyp locations were as follows: right/transverse, 16 (62%); rectum, 7 (27%); and left/sigmoid, 3 (12%). ESD/EMR was successful in 13 patients and WR in 4; 9 patients required CR. Median flatus times were as follows: ESD/EMR, 1 day; WR, 2 days; and CR, 3 days (ESD/EMR vs CR, P = .01). Median length of stay was as follows: ESD/EMR, 3 days; WR, 5 days; and CR, 5 days (ESD/EMR vs CR, P = .0037). There were no leaks or abscesses. Carcinoma was found in 3 patients. Postoperatively, 2 ESD/EMR patients had residual polyp fully removed via a scope.
  
  
  CONCLUSIONS
  ESD/EMR and WR appear to be safe but techniques are evolving. Larger studies are needed.
authors.affiliation: St Luke's Roosevelt Hospital Center, New York, NY, USA.
authors.forename: Joon Ho
authors.initials: JH
authors.lastname: Jang
authors.forename: Daniel
authors.initials: D
authors.lastname: Kirchoff
authors.forename: Kevin
authors.initials: K
authors.lastname: Holzman
authors.forename: Koji
authors.initials: K
authors.lastname: Park
authors.forename: Michael
authors.initials: M
authors.lastname: Grieco
authors.forename: Vesna
authors.initials: V
authors.lastname: Cekic
authors.forename: Samer
authors.initials: S
authors.lastname: Naffouje
authors.forename: Jon
authors.initials: J
authors.lastname: Kluft
authors.forename: Richard L
authors.initials: RL
authors.lastname: Whelan
mesh_terms: D003082:Colectomy / Q000379:methods*; D003111:Colonic Polyps / Q000601:surgery; D003113:Colonoscopy / Q000379:methods*; D015179:Colorectal Neoplasms / Q000601:surgery*; D005260:Female; D006801:Humans; D007413:Intestinal Mucosa / Q000601:surgery; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies