Endoscopy-assisted totally laparoscopic resection of a submucosal tumor of the duodenum

Although, endoscopic polypectomy is one of the first options for diagnosis and treatment of submucosal tumors of the duodenum, it is sometimes difficult for large or sessile tumors. Therefore, local excision or more extended surgery is performed under open laparotomy. In this paper, we present a laparoscopic resection of Brunner's gland hyperplasia of the duodenum which demonstrated rapid interval size change. A 73-year-old male with a histologically unproven submucosal tumor underwent endoscopy-assisted laparoscopic resection of the tumor and intracorporeal suturing of the defect. Simultaneous duodenoscopy and laparoscopy were performed to identify the line of resection. A duodenotomy was performed and the tumor was excised after everting the tumor toward the abdominal cavity. The defect was handsewn with the greater curvature side rolled caudally with an exteriorized stay suture. Postoperative pain was minimal and the patient quickly returned to normal activity. Our new technique provides a minimal invasive treatment for tumors of the duodenum.