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Laparoscopic transduodenal ampullectomy: initial experience from a single center.

Pan Gao1, He Cai1, Zhong Wu1

  • 1Division of Pancreatic Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China.

Frontiers in Oncology
|July 31, 2023
PubMed
Summary

Laparoscopic transduodenal ampullectomy (LTDA) offers a safe and feasible approach for ampulla of Vater tumors, demonstrating reduced operative time, blood loss, and shorter hospital stays compared to other methods. Careful patient selection and multidisciplinary planning are crucial for successful outcomes.

Keywords:
ampulla of Vaterampullectomyfunction-preserving surgerylaparoscopypancreaticoduodenectomy

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Area of Science:

  • Surgical Oncology
  • Gastroenterology
  • Minimally Invasive Surgery

Background:

  • Ampulla of Vater (AoV) tumors pose a surgical challenge, with function-preserving options like Laparoscopic transduodenal ampullectomy (LTDA) being technically demanding.
  • Limited case reports exist for LTDA, necessitating further investigation into its efficacy and safety.

Purpose of the Study:

  • To evaluate the safety and feasibility of LTDA for pre-malignant tumors of the ampulla of Vater.
  • To compare LTDA with laparoscopic pancreaticoduodenectomy (LPD) and open transduodenal ampullectomy (OTDA) in terms of perioperative outcomes.

Main Methods:

  • A retrospective analysis of 43 patients with pre-malignant AoV tumors treated between January 2017 and July 2022.
  • Patients were divided into three groups: LTDA (n=9), LPD (n=19), and OTDA (n=15).
  • Demographic, intraoperative, and postoperative variables were prospectively collected and analyzed.

Main Results:

  • LTDA required significantly less operative time (159.7 min vs. 298.1 min for LPD, p < 0.01) and resulted in lower blood loss (23.3 ml vs. 156.8 ml for LPD, p = 0.002).
  • Patients undergoing LTDA experienced significantly shorter postoperative hospital stays (9.0 days vs. 15.5 days for LPD, p = 0.04) and fewer complications compared to LPD.
  • LTDA also demonstrated reduced blood loss compared to OTDA, with comparable operative times and postoperative outcomes.

Conclusions:

  • LTDA is a safe and feasible surgical option for well-selected patients with pre-malignant tumors of the ampulla of Vater.
  • Multidisciplinary preoperative planning is essential for optimizing patient selection and surgical strategy for LTDA.