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Hammock Method for Duodenal Laparoscopic-Endoscopic Cooperative Surgery: A Field-Stabilizing Technique and Long-Term
Shuhei Komatsu1, Tomoki Konishi2, Takuma Ohashi2
1Department of Digestive Surgery (Esophageal and Gastric Surgery Division), Kyoto First Red Cross Hospital, 15-749 Honmachi, Higashiyama-ku, Kyoto, 605-0981, Japan; Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachihirokoji, Kamigyo-ku, Kyoto 602-8566, Japan.
Background:
Duodenal laparoscopic-endoscopic cooperative surgery is among the most technically demanding applications of this hybrid approach because the thin, mobile wall is difficult to orient and is exposed to bile and pancreatic juice. We developed the Hammock method as a simple field-stabilization technique designed to make this complex surgery safer and more straightforward.
Methods:
Two sutures are placed in normal duodenal wall on opposing sides of the tumor across the short axis and elevated, suspending the target like a hammock. This provides continuous countertraction and a stable view without repeated grasping of the lesion or defect. The platform supported two-layer laparoscopic closure after endoscopic resection of epithelial lesions and full-thickness resection with two-layer closure of subepithelial lesions. We retrospectively analyzed a prospectively maintained registry of 23 lesions in 22 patients treated at two institutions from 2015 to June 2023, with follow-up through August 2026.
Results:
The platform was established in all 23 lesions. Median operative time, blood loss, and postoperative stay were 285minutes, 0 milliliters, and 9 days (range, 7-49), respectively. All five endoscopic-resection perforations were recognized and repaired laparoscopically. Margin-negative resection was achieved in 21 lesions (91.3%). Two patients had minor events; none had Clavien-Dindo grade III or higher morbidity. After at least 3 years 2 months of follow-up, all patients were alive without recurrence.
Conclusions:
Two-point Hammock suspension provided a simple common platform for stable exposure during both procedures. These findings support technical feasibility; comparative validation with objective stability measures is warranted.