Laparoscopic resection of a NET of the CBD with hepaticoduodenostomy

Steven S Rothenberg, MD, FACS, FAAP, Ted Stathos, FAAP. The Rocky Mountain Hospital for Children.

Intro:  This video demonstrates the laparoscopcic resection of a neuroendocrine tumor of the common bile duct (CBD) with a hepaticoduodenostomy

Methods: A 15  year old female presented with evidence of acute cholangitis and evidence of biliary obstruction. Total bilirubin was 2.4 and an ultrasound  showed a markedly dilated common hepatic duct and a question of a large intra-hepatic  stone. An ERCP was performed and the obstructing mass was found to be extra-luminal. A transductal biopsy failed to obtain tissue for diagnosis. An intraductal stent was placed to relieve the obstruction. A CT scan was obtained and showed a 2.5 x 2.5 x 2.4 mass adjacent to and compressing the CBD. A laparoscopic biopsy was performed for diagnosis primarily to rule out lymphoma.

A laparoscopic resection was then performed using 3 – 5mm ports. The specimen was removed thru an enlarged umbilical incision intact inside a specimen bag. Proximal and distal margins were checked for tumor by frozen section.

A hepaticoduodenostomy was then performed to reconstruct the  bile drainage system.

Results: The surgery was completed successfully laparoscopically in 140 minutes. The patient was started on po feeds on the 4^th post-operative day and discharged on day 5. The final pathology showed a Grade 1 neuroendocrine neoplasm with papillary features. There was no evidence of local or distant invasion.

 At 2 week follow-up all lab values had returned to normal. A complete metastatic work-up was negative.

Conclusion: This case presents a rare finding of a primary bile duct tumor. Laparoscopy was a safe and effective technique for resecting the tumor and avoided the morbidity of a large laparotomy without compromising the cancer operation.