Endoscopy-assisted laparoscopic submucosal dissection for a duodenal epithelial tumor

Area of Science:

• Gastroenterology
• Surgical Oncology
• Minimally Invasive Surgery

Background:

• Duodenal adenomas, particularly large or pedunculated ones, pose surgical challenges due to location and vascularity.
• Obesity can further complicate surgical exposure and increase risks in traditional open procedures.
• Standard surgical options like pancreaticoduodenectomy or transduodenal excision carry significant invasiveness and morbidity.

Observation:

• A 46-year-old obese woman presented with a 3.5-cm pedunculated adenoma in the descending duodenum with substantial blood flow.
• Preoperative assessment indicated poor surgical field exposure and high bleeding risk with conventional methods.
• Endoscopic submucosal dissection and open laparotomy were deemed unsuitable due to invasiveness and patient factors.

Findings:

• An innovative endoscopy-assisted laparoscopic submucosal dissection was successfully performed.
• This laparoscopic-endoscopic cooperative approach provided excellent visualization and control.
• The procedure was completed safely, achieving both surgical and oncological goals.

Implications:

• Endoscopy-assisted laparoscopic submucosal dissection represents a promising, minimally invasive surgical strategy for complex duodenal tumors.
• This technique may be particularly beneficial for obese patients or those with tumors in challenging locations.
• Further research into this cooperative approach could expand its application in gastrointestinal surgery.