VM08 - Robotic Wedge Resection of Colonic Schwannoma

Purpose/Background: This is a case of a 54 year old Female with a past medical history notable for a vestibular schwannoma which is surveilled annually with brain MRI. The patient presented with a 2 cm firm submucosal proximal transverse colon lesion identified on screening colonoscopy. Final pathology revealed a colonic schwannoma. This case study will demonstrate how the Da Vinci robotic technology was used to perform a wedge resection of the lesion.

Methods/Interventions: This is a case study of a single patient at Lahey Hospital and Medical Center.

Results/Outcomes: This video demonstrates the steps that were taken to perform a robotic wedge resection of the colonic lesion. The case first begins with colonoscopy to localize the submucosal mass and to place submucosal ink adjacent to the mass for identification of the lesion intraoperatively. We then proceed with diagnostic laparoscopy followed by full thickness excision using the Da Vinci robot. We demonstrate the technique used to close the colotomy in two layers. Finally, we demonstrate how colonoscopy was performed to observe the colon lumen as well as perform a leak test.

Conclusion/Discussion: In the video we describe a robotic wedges resection of a submucosal mass and found the robotic platform helpful for this type of resection.
Colonic schwannomas are rare and are mostly described in the literature as case reports. Most cited cases were managed with oncologic resection of the colon but, there have also been reported cases of full thickness endoscopic removal. As colonic schwannomas are often solitary and benign, though rare cases of distant metastasis and recurrence have been described, treatment with complete surgical resection with negative margins is indicated due to low malignant potential. This can be done with wedge colon resection if feasible rather than segmental resection.
We believe that the use of the minimally invasive approach with the robotic platform with air leak testing is feasible and can avoid the need to perform an oncologic segmental resection.