Direct access robotic excision (DARE): a novel colonoscopy-assisted approach for full-thickness resection of complex...

A subset of colorectal polyps that are non-amenable to endoscopic resection often leads to segmental colectomy despite their benign nature. To provide an organ-preserving alternative, we developed the direct access robotic excision (DARE) procedure, a novel minimally invasive robotic full-thickness excision under colonoscopy guidance. This study reports the feasibility, safety, and outcomes of the robotic DARE procedure and presents a video description of this innovative technique.

We performed a single-center retrospective analysis of a prospectively maintained database of consecutive adults who underwent DARE between March 2020 and March 2026. All patients were referred after unsuccessful attempt at endoscopic resection by an interventional endoscopist. The procedures were performed using the da Vinci Xi or dV5 surgical platform and video-recorded. The primary outcome of this study was the incidence of successful full-thickness excision of the polyps. The secondary outcomes included the 30-day postoperative outcomes. Surgical specimen pathology was assessed to evaluate the completeness of polyp removal and compared with preoperative diagnoses to identify clinically significant upstaging. Representative cases were edited and are provided as a supplementary video demonstrating the key and critical steps of this novel approach.

Forty-four patients (56.8% female; mean age 60.9 years; mean BMI 31.2 kg/m²) underwent the DARE procedure. The mean polyp size was 3.8 cm (0.7-7.8 cm), and the most common locations were the ascending (27.3%) and transverse colon (22.7%). In all cases (100%) robotic full-thickness excision of the polyp was accomplished without segmental resection, and there were no conversions. Adhesiolysis was required in 43.2% of the cases. The mean operative time was 111 min, and the mean estimated blood loss was 50 mL. The mean length of stay was 26.4 h (9-47), and 38 patients (86.4%) were discharged the morning following the procedure. There were no 30-day postoperative complications, readmissions, or reoperations. Final surgical pathology revealed tubular adenoma (31.8%), tubulovillous adenoma (18.2%), sessile serrated adenoma (15.9%), high-grade dysplasia (15.9%), carcinoma in situ (4.5%), invasive adenocarcinoma (2.3%), hyperplastic changes (4.5%), and (6.8%) lipoma. A total of 13 patients (29.5%) had a clinically significant histopathologic upgrade in the final pathology compared with the biopsy findings from colonoscopy.

The robotic DARE procedure is a safe, feasible, and effective approach for complex colorectal polyps that are non-amenable to endoscopic removal. This highly technical approach provides a full-thickness pathological specimen while avoiding the morbidities associated with segmental colon resection. These promising early results support further evaluation of the utility of the robotic DARE approach in the organ-sparing algorithm for the treatment of difficult colonic polyp.