Saline lift colon polypectomies

In this video, we show the case of an 82-year-old man referred to our department with a T2N0M0 cancer of the right colon with four additional concomitant polyps, two pedunculated and two not pedunculated (between 1 and 2cm in size), localized to the left colon. The decision was made first to endoscopically remove the polyps. If the histology of the removed polyps confirmed the complete excision and the absence of invasive cancer, a laparoscopic right hemi-colectomy would be performed. The saline lift technique is demonstrated.

Browse the WORLD
Virtual University
English ▼

Saline   lift   colon   polypectomies

Authors
Gf Donatelli, L Marx, J Marescaux
Abstract
In this video, we show the case of an 82-year-old man referred to our department with a T2N0M0 cancer of the right colon with four additional concomitant polyps, two pedunculated and two not pedunculated (between 1 and 2cm in size), localized to the left colon.
The decision was made first to endoscopically remove the polyps. If the histology of the removed polyps confirmed the complete excision and the absence of invasive cancer, a laparoscopic right hemi-colectomy would be performed. The saline lift technique is demonstrated.
Keywords
Saline lift colon polypectomies
Media type
Duration
06'24''
Publication
2012-01
Popular
Favorites
Favorites Media
Audio
en
Subtitles
en
E-publication
WeBSurg.com, Jan 2012;12(01).
URL: http://www.websurg.com/doi-vd01en3480.htm

Saline   lift   colon   polypectomies

3. Polypectomy 00'51''
The polyp situated more distally was a 1cm, sessile polyp. Using an injection needle, 3cc of normal saline were injected distally behind the lesion, and a submucosal lift was created. The polyp was resected with a standard snare using Endocut™, achieving a nice mucosectomy. The polyp was aspirated in the operating channel and retrieved. Twenty cm away from the anal verge, a 2cm pedunculated polyp was first injected at the level of the stalk. In order to avoid any postoperative bleeding, an Endoloop (Olympus®) was tied at the base of the polyp, which was then snared, resected, and retrieved with a Roth Net®. 5cm away from the anal verge in the rectum, a 1cm semi-pedunculated lesion was removed using the same technique: a lift injection was performed distally and proximally in order to reproduce a pseudo-stalk. The polyp was then snared and cut. The fourth polyp was a 1.5cm pedunculated polyp located 15cm away from the anal verge. The stalk was injected, cut with a snare and retrieved with the Roth Net®. On the stalk, one clip was placed for security purposes. Postoperatively the patient did well, and started a normal diet on the same night. Histology confirmed adenoma with carcinoma in situ for the 2 pedunculated polyps and for the semi-pedunculated polyp with total excision and free resection margins. The first polyp (the one situated more distal to the anus) revealed high-grade dysplasia. In conclusion, we recommend the saline lift technique to remove colonic polyps.