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Robotic Surgery for Benign Duodenal Tumors

  • Original Article
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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Introduction

Benign duodenal and periampullary tumors are uncommon lesions requiring careful attention to their complex anatomic relationships with the major and minor papillae as well as the gastric outlet during surgical intervention. While endoscopy is less morbid than open resection, many lesions are not amenable to endoscopic removal. Robotic surgery offers technical advantages above traditional laparoscopy, and we demonstrate the safety and feasibility of this approach for a variety of duodenal lesions.

Methods

We performed a retrospective review of all robotic duodenal resections between April 2010 and December 2013 from two institutions. Demographic, clinicopathologic, and operative details were recorded with special attention to the post-operative course.

Results

Twenty-six patients underwent robotic duodenal resection for a variety of diagnoses. The majority (88 %) were symptomatic at presentation. Nine patients underwent transduodenal ampullectomy, seven patients underwent duodenal resection, six patients underwent transduodenal resection of a mass, and four patients underwent segmental duodenal resection. Median operative time was 4 h with a median estimated blood loss of 50 cm3 and no conversions to an open operation. The rate of major Clavien-Dindo grades 3–4 complications was 15 % at post-operative days 30 and 90 without mortality. Final pathology demonstrated a median tumor size of 2.9 cm with a final histologic diagnoses of adenoma (n = 13), neuroendocrine tumor (n = 6), gastrointestinal stromal tumor (GIST) (n = 2), lipoma (n = 2), Brunner’s gland hamartoma (n = 1), leiomyoma (n = 1), and gangliocytic paraganglioma (n = 1).

Conclusion

Robotic duodenal resection is safe and feasible for benign and premalignant duodenal tumors not amenable to endoscopic resection.

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Acknowledgments

AJM received an educational grant from Intuitive Surgical within 3 years prior to submission. MEH received a grant from Intuitive Surgical to study methods of robotic training entitled “Robotic Simulator Curriculum, Training, and Validation Program.” SDC and BAB are supported by grant number T32CA113263 from the National Cancer Institute. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Cancer Institute or the National Institutes of Health.

We are indebted to Dr. Lorenzo Anez-Bustillos (BIDMC) for his assistance with the data collection.

Funding Source

Drs. Moser, Kent, Callery, Van der Vliet, and Thoolen are supported by the Griffith Family Foundation and Alliance of Families Fighting Pancreatic Cancer, a nonprofit 501(c)3 foundation. Drs. Downs-Canner and Boone are supported by training grant T32CA113263 from the National Institute of Health.

Conflict of Interest

There are no conflicts of interest involving the work under consideration for publication.

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Authors and Affiliations

  1. Division of Surgical Oncology, University of Pittsburgh, Pittsburgh, PA, USA

    Stephanie Downs-Canner, Brian A. Boone, Amer H. Zureikat, Melissa E. Hogg, David L. Bartlett & Herbert J. Zeh

  2. Institute for Hepatobiliary and Pancreatic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue Stoneman 9, Boston, MA, 02215, USA

    Wald J. Van der Vliet, Stijn J. J. Thoolen, Mark P. Callery, Tara S. Kent & A. James Moser

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  1. Stephanie Downs-Canner
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  2. Wald J. Van der Vliet
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  11. A. James Moser
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Correspondence to A. James Moser.

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Downs-Canner, S., Van der Vliet, W.J., Thoolen, S.J.J. et al. Robotic Surgery for Benign Duodenal Tumors. J Gastrointest Surg 19, 306–312 (2015). https://doi.org/10.1007/s11605-014-2668-0

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  • DOI: https://doi.org/10.1007/s11605-014-2668-0

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