Robotic transduodenal excision of ampullary tumour

Abstract

Ampullary tumours are uncommon lesions with potential risk of malignancy. The management is excision by either endoscopic ampullectomy, pancreaticoduodenectomy or transduodenal excision. Endoscopic ampullectomy offers a less invasive approach, whereas pancreaticoduodenectomy allows radical excision of the tumour. They both carry their own limitations. Transduodenal excision of ampullary tumour offers significantly lower risks with low recurrence rate, and can be offered for benign or early grade tumours. Limited cases of laparoscopic transduodenal excision of ampullary tumours were reported in the literature, probably due to the technical difficulties in performing the operation, especially during the reconstruction of the pancreaticobiliary ducts with the laparoscopic approach. In the era with robotic surgical systems, the technical demanding procedures are greatly facilitated. Hence, we are writing to report a case of transduodenal excision of ampullary tumour with the robot assisted laparoscopic approach.

Robotic Surgery for Benign and Low-Grade Malignant Diseases of the Duodenum

“…[11][12][13][14][15] Although the complication rates in these articles are comparable or slightly better than those described with open surgery, the technical challenges related to complex anatomy of this region, two-dimensional visualization, and rigidity of nonarticulating instruments has limited reproducibility and restricted use of this approach to the hands of a few highly skilled individuals. [13][14][15][16][17] The robotic platform offers several theoretic advantages specific to duodenal and ampullary anatomy 16,17 and can combine the minimally invasive benefits of laparoscopy and endoscopy with visualization and resectional advantages of open surgery. [16][17][18] The three-dimensional imaging, higher magnification, and extreme wrist articulation with the robotic platform provides unmatched visualization and instrument dexterity that is not too dissimilar to conventional open surgery.…”

“…[13][14][15][16][17] The robotic platform offers several theoretic advantages specific to duodenal and ampullary anatomy 16,17 and can combine the minimally invasive benefits of laparoscopy and endoscopy with visualization and resectional advantages of open surgery. [16][17][18] The three-dimensional imaging, higher magnification, and extreme wrist articulation with the robotic platform provides unmatched visualization and instrument dexterity that is not too dissimilar to conventional open surgery. 16 The outcomes reported by our group and others [16][17][18] demonstrate that this technique is a safe and effective modality for many patients with ampullary and periampullary duodenal pathology.…”

“…[11][12][13][14][15] Robotic duodenal surgery (RDS) can combine the benefits of open and laparoscopic approach through better three-dimensional visualization, improved instrument dexterity, and avoidance of larger incisions and can theoretically bridge the gap between endoscopic and surgical treatment strategies for duodenal pathology. [16][17][18] This study is a retrospective review of a single-center experience with robotic surgery (non-PD) for benign and low-grade malignant disease processes of the duodenum.…”

Robotic transduodenal ampullectomy: Case report and review of the literature

“…However, the recent advancements of minimally invasive surgery (MIS) and growing expertise, in particular robotic assisted surgery, meant that some of these challenges could be mitigated. 6 The first case of robotic TDA was reported in 2015. 7 We present a case of a robotic TDA performed for ampullary adenoma with high grade dysplasia and review the existing literature.…”

“…. Wong et al6 presented the first published case of robotic TDA in Asia performed in Hong Kong in 2016, and Lee et al15 presented a series of five cases in Korea in 2018. The overall mean age of patients who underwent robotic TDA was 56 (range, 26-78) years.…”