A Novel Combined Laparoscopic-Endoscopic Cooperative Approach for Duodenal Lesions

Abstract

Abstract

Purpose:

A surgical approach with minimal invasion and excellent outcome for removal of duodenal lesions, using laparoscopic-endoscopic cooperative surgery (LECS), was established.

Patients and Methods:

Two patients underwent the resection of duodenal lesions with our novel LECS approach. Case 1 (age: 49 years; male) had a 20-mm 0–IIa-like lesion (group IV tumor on biopsy) in the duodenal bulb. LECS interventions, performed under general anesthesia, employed a total of four trocars. The extent of lesions was determined with the endoscopic submucosal dissection (ESD) technique. The affected duodenal wall was then perforated before a one fifth turn resection was performed to expose lesions of the whole layer. A tumor, confirmed under laparoscopy, was turned over toward the abdominal cavity to facilitate resection. Case 2 (age: 49 years; female) had 20-mm 0–IIc lesions (group III adenoma) located at the second portion of the duodenum. LECS procedures for duodenal resection were performed in a manner similar to case 1. A total of five trocars were used.

Results:

Histologic diagnosis of the tumor in case 1 was tubular adenoma with moderate atypia (size: 20 × 12 mm). As for case 2, histopathologic findings confirmed a tubular adenoma with moderate atypia (size: 18 × 18 mm) and an adenoma-negative surgical margin. The postoperative courses, in both cases, were uneventful.

Conclusions:

Although only 2 cases were surgically intervened with limited experience, the present novel LECS approach allowed a reliable, adequate resection of tumors located in the duodenum, with abbreviated operation times (156–179 versus 202–229 minutes), minimal bleeding, less postoperative stress imposed on the surgeons, and an uneventful postoperative course, compared to conventional surgical methods.