A Novel Technique for Duodenal Resection and Primary Anastomosis With Robotic Assistance and OrVil

Abstract

Background and Objectives:Benign duodenal neoplasm is a rare occurrence. Minimally invasive tumor resection and anastomosis formation with an OrVil catheter is a novel approach to treating this disease. In this article, we present a new technique for duodenojejunal anastomosis. This technique was applied in 4 patients with benign distal duodenal tumors who were treated with minimally invasive surgery with robotic assistance.Methods:In 4 patients, after the removal of distal duodenal masses with a robotic technique, an orifice in the duodenum was opened to allow for the passage of a guidewire. The guidewire was removed from the orifice by holding it with forceps during an upper endoscopy. An OrVil catheter was sutured to the guidewire outside to allow 2 catheters to proceed consecutively. After the removal of the anvil, an end-lateral duodenojejunostomy was performed with a circular stapler.Results:The patients included 3 men and 1 woman (average age, 56). The durations of the operations were 215, 175, 180, and 185 minutes. No complications were observed in any of the patients during the postoperative period. The patients began oral intake on the fifth day of the postoperative period, and they were discharged on the sixth postoperative day. Histopathologic analyses indicated that the removed tumors were adenomas in 2 patients and gastrointestinal stromal tumors (GISTs) in 2 patients. Clear surgical margins were observed in all of the patients.Conclusion:The placement of an OrVil catheter for anastomosis in benign neoplasms with distal duodenum localization and the subsequent achievement of duodenojejunal anastomosis with a circular stapler constitute a novel treatment approach.

Modified reverse-puncture anastomotic technique vs. traditional technique for total minimally invasive Ivor-Lewis esophagectomy

“…The main advantage of McKeown surgery is that even if an anastomotic fistula occurs, it is not a fatal complication, and more conservative treatment can be used to heal. However, compared with Ivor-Lewis operation, the procedure is cumbersome, the operation time is long, the trauma is large, and the symptoms of hoarseness, drinking cough, anastomotic fistula, and anastomotic stenosis during perioperative period seriously affect the quality of life of patients, which is contrary to the original intention of minimally invasive surgery [7]. Therefore, it is ideal for the use of minimally invasive Ivor-Lewis esophagectomy (MIILE) for the middle and lower esophageal cancer.…”

Surgical Management of Benign Neoplasms of the Small Intestine

“…According to the research, tumours that are removed before they perforate or the start of a major gastrointestinal (GI) bleeding have a very good prognosis. There have been descriptions of laparoscopic, endoscopic, and robotic-assisted techniques [2, [18][19][20][21][22][23]. The utilisation of laparoscopic surgery (LS) for small intestine GISTs has expanded with the introduction of LS.…”