A Novel Combined Laparoscopic-Endoscopic Cooperative Approach for Duodenal Lesions

Abstract

Although only 2 cases were surgically intervened with limited experience, the present novel LECS approach allowed a reliable, adequate resection of tumors located in the duodenum, with abbreviated operation times (156-179 versus 202-229 minutes), minimal bleeding, less postoperative stress imposed on the surgeons, and an uneventful postoperative course, compared to conventional surgical methods.

Laparoscopy Assisted Transduodenal Resection of a Periampullary Tumor at the Inferior Duodenal Angulus

“…Application of LECS to non-ampullary duodenal tumors has also been reported [3,4]. LECS is a very useful procedure for duodenal tumors.…”

“…Further, endoscopic removal of a tumor at the inferior duodenal angulus on the ampullary side is extremely difficult if not impossible. Laparoscopic-Endoscopic Cooperative Surgery (LECS) has been described as a minimally invasive and reliable means of resecting non-ampullary duodenal tumors [3,4]. However, removal of a tumor located at the ampulla or on the distal side is difficult to achieve with LECS.…”

Laparoscopic and endoscopic cooperative surgery for non-ampullary duodenal epithelial neoplasms

“…Duodenal stenosis occurred in the case of open conversion but was treated by repeated endoscopic balloon dilatation. ESD: endoscopic submucosal dissection In the literature [10][11][12][13][14][15] , a total seven authors reported a series of LECS for NADENs where the lesions were treated by either ESD and subsequent laparoscopic repair or endoscopy-assisted laparoscopic full-thickness resection and repair without any serious intra-and postoperative complications, corresponding to our results [ Table 3]. In those reports, surgery was occasionally performed for adenocarcinomas confined in the mucosa, but no tumor recurrence was noted in the postoperative course, revealing the feasibility of the indication of LECS for NADENs.…”

“…Similarly, recent reports demonstrated that LECS offers a promising procedure of choice to facilitate less invasive surgery in the treatment of NADENs [10][11][12][13][14][15] , but the clinical evidence verifying its efficacy remains limited. In this report, we sought to investigate our initial experience of LECS for NADENs and further reveal its clinical significance.…”

Commentary on Laparoscopic-Endoscopic Cooperative Surgery for Duodenal Lesions

“…Under the LECS approach, the tumor can be resected with minimal but adequate surgical margin. We reported LECS for duodenal lesions in 2010 [4], but other such reports limited. Although LECS enables resection of the tumor with minimal but adequate surgical margin and without postoperative deformity or stenosis, the procedure is still not fully established.…”