Robotic-Assisted Resection of a Giant Sigmoid Colonic Lipoma: A Case Report.

Colonic lipomas (CLs) are rare, benign non-epithelial tumors composed of adipose tissue. While most CLs are asymptomatic, those exceeding 2 cm can cause symptoms such as abdominal pain, bowel obstruction, intussusception, rectal bleeding, or perforation. Surgical resection is indicated in symptomatic cases or when malignancy cannot be ruled out. Although laparoscopic surgery has been the standard minimally invasive approach, robotic-assisted surgery has emerged as an alternative with enhanced precision and visualization. Herein, we report a rare case of a giant sigmoid CL successfully treated with robotic-assisted colectomy. An 85-year-old man with a history of open distal gastrectomy and chronic heart failure initially presented with rectal mucosal prolapse four years prior. Colonoscopy and MRI identified a submucosal tumor (SMT) measuring approximately 5 cm, diagnosed as a large sigmoid CL. The patient opted for surveillance with MRI every six months, during which no symptoms developed. However, after four years, he experienced a recurrence of rectal mucosal prolapse accompanied by bloody stool, prompting the decision for elective surgery. A robotic-assisted sigmoid resection was performed using a medial approach, preserving the left colic artery while dissecting the superior rectal and sigmoid arteries. The rectum was transected with a 60-mm stapler, and reconstruction was performed using the double-stapling technique. The procedure was completed without complications, and pathological analysis confirmed the diagnosis of a benign submucosal lipoma. The patient was discharged two weeks postoperatively and remained recurrence-free with restored bowel function at an eight-month follow-up. This case illustrates that when CLs grow beyond 2 cm and become symptomatic, surgical resection should be considered, and robotic-assisted colectomy can be a feasible option.