Laparoscopic and endoscopic co-operative surgery for non-ampullary duodenal tumors

Figure 1 Trocar arrangement for duodenal laparoscopic and endoscopic co-operative surgery. A 12-mm trocar was placed through the umbilicus as a camera port. Four additional trocars were located symmetrically along the line connecting the location of the target tumor and the umbilicus.

Figure 2 Laparoscopic and endoscopic co-operative surgery procedure for a duodenal submucosal tumors. A: Endoscopic view of a duodenal neuroendocrine tumor; B: Endoscopic view of a full-thickness dissection; C: Laparoscopic view after full-thickness excision; D: Laparoscopic view after closure using hand-sewn sutures.

Figure 3 Laparoscopic and endoscopic co-operative surgery procedure for a superficial epithelial tumor. A: Endoscopic view of a duodenal mucosal tumor; B: Endoscopic view of the ulcer bed after endoscopic submucosal dissection; C: Laparoscopic view after reinforcement using hand-sewn sutures; D: Endoscopic view after the sutures.

Figure 4 Cine-magnetic resonance imaging findings of duodenal contraction. These figures are in the following order: A→B→C→D→E→F. White arrows show the second part of the duodenum. They show the presence of periodic active peristalsis in the duodenum.