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Feasibility and Safety of a Novel Laparoscopic and Endoscopic Cooperative Surgery Technique for Superficial Duodenal Tumor Resection: How I Do It

  • Yoshitomo YanagimotoEmail author
  • Takeshi Omori
  • Moon Jeong-Ho
  • Naoki Shinno
  • Kazuyoshi Yamamoto
  • Yoji Takeuchi
  • Koji Higashino
  • Noriya Uedo
  • Keijiro Sugimura
  • Tomoyuki Matsunaga
  • Hiroshi Miyata
  • Hajime Ushigome
  • Yusuke Takahashi
  • Junichi Nishimura
  • Masayoshi Yasui
  • Kei Asukai
  • Daisaku Yamada
  • Akira Tomokuni
  • Hiroshi Wada
  • Hidenori Takahashi
  • Masayuki Ohue
  • Masahiko Yano
  • Masato Sakon
How I do it

Abstract

Background

Pancreatoduodenectomy is considered to be a very invasive treatment for early superficial duodenal tumors (SDTs), which have a lower risk of lymph node metastasis. Partial resection of the duodenum with endoscopic submucosal dissection for SDT resection is an attractive technique but it is associated with a high risk of complications. We describe our technique for SDT resection.

Method

It includes the following elements: freeing the transverse mesocolon, exposing and mobilizing the second part of the duodenum and the head of the pancreas (Kocher maneuver), confirming the location of the ulcer bed for endoscopic submucosal dissection, and laparoscopic suturing by hand in the seromuscular layer of the duodenum. We performed this technique in 10 patients between March 2015 and March 2017.

Results

The median tumor diameter and resected tissue diameter were 36 (20–54) and 41 (25–60) mm, respectively. Curative resection (R0) with negative margins was achieved for all patients. There were no conversions to open surgery in this series. No postoperative complications were above grade 2 in the Clavien-Dindo classification system. No recurrences were observed during the medium-term follow-up period.

Conclusion

This technique is safe and feasible and can be an option for surgical SDT resection.

Keywords

Duodenal tumor Laparoscopic and endoscopic cooperative surgery LECS 

Notes

Authors’ Contributions

Yoshitomo Yanagimoto designed the study and wrote the initial draft of the manuscript. Takeshi Omori contributed to the analysis of data and interpretation of results and assisted in the preparation of the manuscript. All other authors contributed to data collection and interpretation of results and critically reviewed the manuscript. All authors approved the final version of the manuscript and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

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Copyright information

© The Society for Surgery of the Alimentary Tract 2019

Authors and Affiliations

  • Yoshitomo Yanagimoto
    • 1
    Email author
  • Takeshi Omori
    • 1
  • Moon Jeong-Ho
    • 1
    • 2
  • Naoki Shinno
    • 1
  • Kazuyoshi Yamamoto
    • 1
  • Yoji Takeuchi
    • 3
  • Koji Higashino
    • 3
  • Noriya Uedo
    • 3
  • Keijiro Sugimura
    • 1
  • Tomoyuki Matsunaga
    • 4
  • Hiroshi Miyata
    • 1
  • Hajime Ushigome
    • 1
  • Yusuke Takahashi
    • 1
  • Junichi Nishimura
    • 1
  • Masayoshi Yasui
    • 1
  • Kei Asukai
    • 1
  • Daisaku Yamada
    • 1
  • Akira Tomokuni
    • 1
  • Hiroshi Wada
    • 1
  • Hidenori Takahashi
    • 1
  • Masayuki Ohue
    • 1
  • Masahiko Yano
    • 1
  • Masato Sakon
    • 1
  1. 1.Department of Gastroenterological SurgeryOsaka International Cancer InstituteOsakaJapan
  2. 2.Department of SurgeryNTT West Osaka HospitalOsakaJapan
  3. 3.Department of Gastrointestinal OncologyOsaka International Cancer InstituteOsakaJapan
  4. 4.Department of Surgery, School of MedicineTottori University Faculty of MedicineTottoriJapan

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