Defining Precision Surgery: Totally Laparoscopic Transduodenal Ampullectomy : A Combined Approach Aims for Margin...

Area of Science:

• Gastroenterology
• Surgical Oncology
• Minimally Invasive Surgery

Background:

• Ampullary adenomas are premalignant lesions requiring resection.
• Standard resection options include pancreatoduodenectomy and surgical or endoscopic ampullectomy.
• Transduodenal minimally invasive ampullectomy is a less aggressive alternative when endoscopic resection is not feasible.

Purpose of the Study:

• To present a combined surgical approach to enhance precision during transduodenal minimally invasive ampullectomy.
• To achieve complete resection of ampullary adenomas with free margins, minimizing local recurrence.

Main Methods:

• A 64-year-old female patient with an ampullary adenoma not amenable to endoscopic resection underwent laparoscopic ampullectomy.
• A combined strategy included choledochoscopy for lesion visualization, intraoperative ultrasound for tumor assessment, and indocyanine green with a Fogarty catheter for margin exposure.

Main Results:

• The procedure was completed in 416 minutes with an uneventful postoperative course.
• Pathology confirmed a well-demarcated adenoma with low-grade dysplasia and free margins.
• The patient remained asymptomatic with no evidence of recurrence at 24 months post-surgery.

Conclusions:

• Transduodenal minimally invasive ampullectomy is a technically demanding procedure.
• The presented combined approach utilizing advanced technologies enhances surgical precision.
• This strategy enables free-margin anatomical resection for ampullary adenomas.