Hybrid Laparoscopy-Assisted Transduodenal Ampullectomy for Benign Ampullary Tumor

Ching-Yao Yang, MD, I-Rue Lai, MD PhD, Ming-Tsan Lin, MD PhD, Po-Huang Lee, MD PhD, Yu-Wen Tien, MD PhD. National Taiwan University Hospital

Introduction:
When the size or extent of the ampullary tumors is beyond the indication of endoscopic ampullectomy, open transduodenal ampullectomy or pancreaticoduodenectomy is indicated. In recent years, the application of minimal invasive surgery has been widened. However, minimal invasive transduodenal ampullectomy has been rarely reported. The purpose of this study is to report two cases, and video-share our experience by using laparoscopy-assisted transduodenal ampullectomy for benign ampullary tumors.
Methods and Procedures:
Case 1 is a 68-year-old male with past history of stroke and hemiplegia 10 years before. He was admitted due to recurrence of ampullary adenoma which has been resected by endoscopic approach one year before. The 2-cm-sized polypoid tumor was examined by EUS, and biopsy revealed a benign adenoma. Case 2 is a 50-year-old female, who has past history of pancreatitis one year before, was noted to have a 2.5cm polypoid ampullary tumor during panendoscopic exam. Biopsy revealed a benign tubulovillous adenoma at ampulla of vater. Both patients received laparoscopy-assisted transduodenal ampullectomy. The perioperative parameters, morbidity, and follow-up results were analyzed.
Results:
Case 1 patient underwent gasless laparoscopy-assisted cholecystectomy, transduodenal ampullectomy, gastrojejunal anastomosis, and T-tube jejunostomy implantation. Case 2 patient underwent two-stage operation. The first stage of duodenal Kocher maneuver, soft tissue dissection, and localization was performed under pure laparoscopic procedure. The second stage of transduodenal ampullary tumor resection, and sphinteroplasty was performed under gasless laparoscopy-assisted procedure. Operative time is 240 min, and 150 min, respectively. Estimated blood loss is less than 100cc for both cases. The first case was complicated by atelectasis, and pneumonia, and mild pancreatic juice leak. The second case has no any morbidity, and discharged on postoperative 6 days.
Conclusion:
Hybrid, two stages, laparoscopy-assisted transduodenal ampullectomy for benign ampullary tumors is feasible, and could be considered as another treatment modality in selected patients.