V16 - Endorobotic Submucosal Dissection (ERSD) of Two Large Rectal Lesions

Purpose/Background: Historically, large premalignant and low grade malignant rectal lesions were managed with surgical resection, requiring proctectomy. In the age of rapidly evolving endoluminal surgical capabilities, the clinical indications for surgical resection and opportunities to maximize organ preservation are being re-examined.

Methods/Interventions: We present two cases involving two large polypoid rectal lesions deemed unresectable by traditional endoscopic technique. The first was a 60-year-old male with a nearly circumferential villous rectal lesion located 10cm from the anal verge with biopsy consistent with villous adenoma with focal high-grade dysplasia. Preoperative MRI was concerning for focal extension into the mesorectal fat, characterized as T3bN0. The second case was a 67-year-old male referred with a 50mm proximal rectal lesion 15cm from the anal verge with biopsy demonstrating tubulovillous adenoma. Both patients were referred for consideration of endorobotic submucosal dissection which they underwent utilizing the Da Vinci Single Port platform.

Results/Outcomes: Both large, nearly circumferential rectal lesions were resected en bloc endorobotically. Both patients were discharged the same day without complications and required no further treatment. The first patient’s pathology demonstrated traditional serrated adenoma (TSA) with extensive high-grade dysplasia, negative for carcinoma. The second patient’s pathology was consistent with tubulovillous adenoma with TSA-like features.

Conclusion/Discussion: Endorobotic submucosal dissection offers a technically feasible and safe approach with both diagnostic and therapeutic intent in the management of large rectal lesions which would otherwise require proctectomy, particularly those with discordant preoperative imaging.