Laparoscopy Assisted Transduodenal Resection of a Periampullary Tumorat the Inferior Duodenal Angulus

Background: Duodenal adenoma is a rare lesion that requires resection because of its malignant potential. Minimally invasive surgery is desirable for such lesions. Case summary: A 52-year-old man underwent esophagogastroduodenoscopy, which revealed a 30-mm 0-IIalike lesion at the inferior duodenal angulus. Examination of the biopsy specimen revealed a Group IV adenoma. The tumor was treated by laparoscopic transduodenal ampullectomy, which was performed under general anesthesia and via 5 trocars. After laparoscopic mobilization of the duodenum and pancreas head, the duodenum was externalized through a mini-laparotomy. A longitudinal incision was placed in the duodenum, and the tumor was excised extracorporeally under direct vision; submucosal dissection was achieved with an electrocautery device. The mucosal defect and duodenal wall were closed with interrupted sutures. The tumor measured 26 mm × 25 mm and was diagnosed histologically as a tubular adenoma with low grade atypia. The surgical margin was adenomanegative. The postoperative course was uneventful. Conclusion: From our experience in this case, we deem laparoscopy-assisted transduodenal ampullectomy to be a feasible and safe procedure for a periampullary duodenal tumor.