UCLA team removes suspicious polyp with new alternative that keeps colon intact

Robert Greenwald was told after a routine colonoscopy that he had a suspicious polyp that was a little bigger than a quarter in a hard-to-reach place that was going to require major surgery to remove – even though it wasn’t certain if the polyp was cancerous or not.

Greenwald, age 58, who has no history of colon cancer in his family, thought that removing a section of his colon containing the polyp sounded drastic. Especially since only 15 percent of all polyps turn out to be malignant, according to UCLA experts.

He looked for an alternative and found that a UCLA team of surgeons and gastroenterologists have been performing a new minimally-invasive procedure to remove large polyps in hard-to-reach places while keeping the colon intact.

The procedure, called CELS, combines two minimally invasive techniques – endoscopy and laparoscopic surgery. Currently, it has only been performed at a handful of medical centers in the United States.

“With the advent of new technology, we have the ability to develop new techniques like CELS to help address more individual needs of patients, ” said Anne Lin, MD, assistant professor-in-residence of general surgery at the David Geffen School of Medicine at UCLA. “The approach may prove to be a viable option for patients like Mr. Greenwald.”

The new technique starts out like a colonoscopy, with a gastroenterologist advancing an endoscope inside the colon. The endoscope, a device with a small video camera and a light attached, lets doctors look inside the body cavity. Once a polyp is in sight and the gastroenterologist is ready to remove it, the surgeon uses minimally invasive surgical tools, inserted through two to four tiny incisions in the abdomen, to carefully maneuver and manipulate the colon, allowing the gastroenterologist better access to the polyp.

Greenwald’s two centimeter-sized polyp was in a tricky location, in the juncture of the small and large intestine. The surgical team gently maneuvered Greenwald’s colon to allow UCLA gastroenterologist Kevin Ghassemi, MD, better access to remove it.

Once the polyp was removed, it was immediately taken to the lab for analysis to determine if it was benign or cancerous, while the team and patient waited in the operating room. The analysis takes about 30 minutes. If the polyp turns out to be cancerous, the team proceeds with standard surgery to remove the affected portion of the colon.

Much to Greenwald’s relief, his polyp turned out to be benign. The two-hour procedure went smoothly and he was discharged later that day.

“I couldn’t believe how easy it was,” said Greenwald. “I feel like it was quick and efficient. I had the procedure in the morning and was out by the afternoon with no discomfort,” said Greenwald, a software quality engineer who is married with two sons. He even walked around the UCLA campus the next day and was back playing tennis the following week.

“The CELS procedure demonstrates an important collaboration between the gastroenterology and surgery departments that can help us offer more minimally invasive options to patients,” said Ghassemi, an assistant professor in the division of digestive diseases at the UCLA Health System and the Geffen School of Medicine.

As for Greenwald, he hasn’t missed a beat. He is now a strong proponent of the importance of receiving a routine colonoscopy. He has even encouraged other family members to have the preventive procedure.

Colorectal cancer is the third most common cancer and second leading cause of cancer-related death.

Physicians note that patients who successfully undergo the CELS procedure still require follow-up endoscopic evaluation and that surgery is still the standard treatment for cancer or cancerous polyps — or if the polyp cannot be removed endoscopically even with the CELS technique.

To learn more about the CELS procedure, visit UCLA Colorectal Surgery.


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