title: Full-thickness laparoendoscopic colonic excision in an experimental model.
abstract: BACKGROUND
  Patients requiring surgery for complex colonic polyps traditionally undergo colectomy, with significant risks. Typically in excess of 10-30 cm of colon is removed at laparoscopic or open surgery lasting over 60 min. This study details the preclinical development of a rapid, minimally invasive, limited full-thickness colonic resection.
  
  
  METHODS
  Both survival and non-survival procedures were performed in anaesthetized 70-kg pigs. A simulated colonic polyp was created by endoscopic ink injection with a clearance margin delineated by circumferential placement of mucosal argon plasma coagulation marks. Full-thickness eversion of the bowel was achieved using endoscopically placed anchors and the polyp was excised using a laparoscopic stapler. In survival procedures, pigs were killed under anaesthetic 8 days after surgery. All pigs underwent post-mortem examination.
  
  
  RESULTS
  Five procedures were performed (5 pigs). The median (range) procedure duration was 26 (20-31) min, with a specimen diameter of 5.1 (4.5-6.3) cm. The postoperative recovery of survival animals (4 pigs) was uneventful. At post-mortem evaluation the resection sites were well healed with no evidence of stenosis, intra-abdominal infection or inadvertent organ damage. Histological assessment of anastomoses showed mucosal repair and restoration of submucosal continuity.
  
  
  CONCLUSIONS
  Full-thickness localized colonic excision with this technique provides a large specimen with adequate healing in a porcine model.
authors.affiliation: Department of Surgery and; Wolfson Unit for Endoscopy, St Mark's Hospital and Academic Institute.
authors.forename: A
authors.initials: A
authors.lastname: Brigic
authors.forename: A
authors.initials: A
authors.lastname: Southgate
authors.forename: P
authors.initials: P
authors.lastname: Sibbons
authors.forename: S K
authors.initials: SK
authors.lastname: Clark
authors.forename: C
authors.initials: C
authors.lastname: Fraser
authors.forename: R H
authors.initials: RH
authors.lastname: Kennedy
mesh_terms: D000714:Anastomosis, Surgical / Q000379:methods; D000818:Animals; D003106:Colon / Q000601:surgery*; D003111:Colonic Polyps / Q000601:surgery*; D003113:Colonoscopy / Q000379:methods*; D003250:Constriction; D004195:Disease Models, Animal; D010535:Laparoscopy / Q000379:methods*; D011184:Postoperative Period; D017792:Surgical Stapling; D034421:Sus scrofa; D014945:Wound Healing / Q000502:physiology