Abstract
Background
Some authors previously reported that early ampulla of Vater neoplasms have a low potential of lymph node metastasis and favorable prognosis and, therefore, could be indicated for limited resections instead of the standard pancreatoduodenectomy (PD). In limited resections, when compared to endoscopic papillectomy, transduodenal papillectomy is less technically demanding and a sufficient surgical margin can be achieved due to the greater extent of the excisional area. This didactic video article demonstrated our standardized laparoscopy-assisted transduodenal papillectomy (LATDP).
Methods
The technique consisted of 3 steps: laparoscopic Kocher mobilization, papillectomy, and reconstruction. This laparoscopy-assisted approach was more favorable than the pure laparoscopic approach as there was no tumor exposure in the abdominal cavity, which might potentially lead to intraabdominal tumor dissemination.
Results
Our LATDP served as a total biopsy to decide whether the subsequent PD was inevitable to patients with early ampulla of Vater neoplasms.
Conclusion
This procedure provides the benefit of minimal invasiveness and oncological safety. Therefore, it should be considered as an option in the armamentarium of modern pancreatic and biliary tract surgeries.
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References
Kimura W, Miyata H, Gotoh M et al (2014) A pancreaticoduodenectomy risk model derived from 8575 cases from a national single-race population (Japanese) using a web-based data entry system: the 30-day and in-hospital mortality rates for pancreaticoduodenectomy. Ann Surg 259:773–780
Aiura K, Hibi T, Fujisaki H et al (2012) Proposed indications for limited resection of early ampulla of Vater carcinoma: clinic-histopathological criteria to confirm cure. J Hepatobiliary Pancreat Sci 19:707–716
Sperti C, Pasquali C, Piccoli A et al (1994) Radical resection for ampullary carcinoma. Long term results. Br J Surg 81:668–671
Schneider L, Contin P, Fritz S et al (2016) Surgical ampullectomy: an underestimated operation in the era of endoscopy. HPB (Oxford) 18:65–71
Honda G, Kurata M, Matsumura H et al (2010) Laparoscopy-assisted transduodenal papillectomy. Dig Surg 27:123–126
Shen MY, Huang IP, Chen WS et al (2008) Influence of pneumoperitoneum on tumor growth and pattern of intra-abdominal tumor spreading: in vivo study of a murine model. Hepatogastroenterology 55:947–951
Acknowledgements
The authors would like to thank Yosuke Morimoto MD, Gaku Shimane MD, and Kodai Abe MD for their contribution to the acquisition of data, as well as Koichi Aiura for the initiation of the open TDP in our institute.
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All procedures performed in the present study involving a human participant were in accordance with the ethical standards of the institutional research committee, as well as with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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Informed consent for publication was obtained from the patient included in the article.
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The authors declare no competing interests.
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Wakabayashi, T., Kitago, M. & Kitagawa, Y. Laparoscopy-assisted transduodenal papillectomy: how we do it (with video). Langenbecks Arch Surg 406, 2887–2890 (2021). https://doi.org/10.1007/s00423-021-02289-4
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DOI: https://doi.org/10.1007/s00423-021-02289-4