V90 - The Robot Isn’t Always Necessary: Laparoscopic TAMIS Management of Two Endoscopically Unresectable Rectosigmoid Polyps

Purpose/Background: The widespread adoption of the robotic surgery platform has decreased the frequency that a laparoscopic TAMIS is performed. The following case demonstrates an endoscopically unresectable 6cm rectosigmoid polyp that was completely excised using laparoscopy.

Methods/Interventions: We present a laparoscopic-assisted transanal minimally invasive resection of two endoscopically unresectable rectosigmoid polyps.

Results/Outcomes: This is a 53-year-old male with no significant past medical or surgical history who initially presented in July 2025 for a colonoscopy in the setting of diarrhea and hematochezia. His colonoscopy was significant for a fungating, partially obstructing mass in the rectosigmoid colon that was biopsied and consistent with a tubulovillous adenoma.

On repeat sigmoidoscopy and endoscopic ultrasound, the mass was found to be 5-6 cm in size and 12cm from the anal verge. The mass had no nodal involvement, with only mucosal involvement appreciated. The mass was unable to be resected endoscopically; he was therefore referred for surgical resection. Given these findings, he was deemed an appropriate candidate for a laparoscopic TAMIS.

Intraoperatively, a Gelpoint Path TAMIS port was inserted into the anal canal and secured to the perineal skin with O-silk sutures. CO2 insufflation was initiated. We immediately localized the broad base 5x6cm lesion about 12cm from the anal verge, consistent with the previously identified and biopsied mass. The polyp was lifted from the muscular layer with Eleview injection into the submucosa. The circumferential edge was marked around the polyp, ensuring for 0.5 cm margins. The polyp was then removed en bloc, ensuring separation of the submucosa from the underlying muscularis. The defect was closed with a 3-0 continuous V-lock suture. Notably, there was a second, smaller polyp on the right lateral wall that was removed with the same methods.

The patient had an uneventful postoperative period and was discharged the same day. On final pathology, the smaller polyp was a tubular adenoma, and the larger polyp was consistent with a tubulovillous adenoma with multiple foci of intramucosal carcinoma.

Conclusion/Discussion: The use of laparoscopy in TAMIS remains a vital tool in a colorectal surgeon’s management of low-lying endoscopically unresectable polyps. Careful patient selection allows for complete resection of high-risk polyps with organ preservation and without the need for a robotic platform.