Laparoscopically assisted colonoscopic polypectomy (LACP) and minimally invasive alternatives for benign colorectal polyps: impact, versatility, and follow-up

Up to 15% of colorectal polyps remain endoscopically unresectable, often leading to segmental colectomy, which carries significant morbidity. Laparoscopically assisted colonoscopic polypectomy (LACP) is an emerging minimally invasive alternative. This study evaluated the role of LACP in achieving complete polypectomy, minimizing perioperative complications and preventing recurrence, specifically in elderly comorbid patients, while also describing complementary minimally invasive procedures for challenging benign colorectal polyps. This retrospective single-center, cohort study included all patients with benign, endoscopically unresectable colorectal polyps treated at a tertiary care center between September 2017 and September 2023. Forty-seven patients underwent minimally invasive interventions: 22 LACP, 15 polypectomy under general anesthesia, and 10 extended appendectomy. Among LACP cases, mean age was 72 years and mean ASA score was 3. Complete polypectomy was achieved in 86.4% with benign histopathology confirmed in all cases. Conversion to laparoscopic colectomy was required in 13.6% due to incomplete polypectomy. Complications occurred in 13.6% including two laparoscopically repaired perforations and one self-limited bleed. Same-day discharge was achieved in 81.8%. Follow-up colonoscopy at 6 and 18 months demonstrated no recurrence in 86.4% of patients while 11.1% developed unresectable recurrence requiring colectomy. Overall, colectomy was avoided in 80.4% of patients. LACP seems safe and effective for complex benign colorectal polyps, particularly in elderly comorbid patients. It offers high rates of complete resection, low recurrence, same-day discharge, and the possibility for intraoperative rescue procedures. When standard endoscopic resection fails, LACP and complementary minimally invasive procedures are valuable alternatives and should be considered within a multidisciplinary framework.