The aim of this study was to review our experience with the hand-assisted laparoscopic management of duodenal tumors with no or low malignant potential and to compare this approach with published case reports of purely laparoscopic local duodenal resection.

Eight cases of hand-assisted laparoscopic local duodenal resection performed from 2000 to 2008 were retrospectively reviewed. Hand-assistance was utilized for complete duodenal mobilization, and local duodenal resection was accomplished extracorporeally through the hand-access incision. Patient and tumor characteristics, operative time, length of stay, and complications were compared with 18 cases of totally laparoscopic local excision of duodenal tumors published since 1997. Patients with ampullary tumors were excluded.

Compared with the purely laparoscopic approach, the hand-assisted technique was associated with shorter operative time (179 versus 131 minutes, P=.03) and was more commonly used for lesions located in the third portion of the duodenum (0% versus 37.5%, P=.02). Tumor size (2.9 cm versus 3.2 cm, P=.61) and length of hospital stay (5.9 versus 5.9 days, P=.96) were similar between the two groups. The rate of complications was also comparable (0% versus 12.5%, P=.31); 1 of 8 patients in the hand-assisted group developed an incisional hernia at the hand-access site.

Hand-assisted laparoscopic local duodenal resection is a feasible, safe, and effective alternative to the totally laparoscopic approach. In addition to being associated with comparable length of hospital stay, hand-assistance can shorten operative time by facilitating duodenal mobilization as well as extracorporeal duodenal resection and closure.

Duodenal sporadic adenomatous polyps are rare findings during upper endoscopy. Resection is indicated due to their malignant potential.

A 55 year-old male patient was diagnosed with a 3 cm duodenal adenomatous polyp with low-grade dysplasia, which could not be safely resected by endoscopy. A transduodenal submucosal robotic-assisted polypectomy was performed.

The operative time was 4.5 h, with an estimated blood loss of 200 ml. The patient had a normal bowel transit on postoperative day 3 and he was discharged on postoperative day 7. Three months follow-up was uneventful. The final histological finding revealed a completely resected duodenal adenomatous polyp without signs of malignancy.

Robotic-assisted resection of duodenal polyps is a feasible technique that may be indicated for the local excision of duodenal lesions that cannot be endoscopically resected. Compared to the open and laparoscopic approach, it offers many technical advantages.

To evaluate the feasibility and efficacy of laparoscopic wedge resection with handsewn closure in gastroduodenal tumors.

Laparoscopic wedge resection was performed in 16 patients with gastroduodenal tumor between May 2000 and December 2002. Every case, except one, was performed via an extragastric approach; a transgastric approach was adopted in a single case. Excision of the lesion was performed manually by means of electrocautery or ultrasonic coagulating shears and closed by manual intracorporeal running suture.

Among the 16 cases, two cases were treated using a laparoscope-assisted method, but there was no case of conversion to open surgery. Mean size of lesions was 27.9 mm in diameter and the mean operation time was 219 minutes. In all cases, a complete tumor excision with negative surgical margins was obtained. The final pathologic diagnoses were ectopic pancreas (4 cases), gastrointestinal stromal tumor (3 cases), leiomyoma (2 cases), adenomyoma (2 cases), tubular adenoma (1 case), Brunner's gland hyperplasia (1 case), carcinoid tumor (1 case), eosinophilic granuloma (1 case), and post-endoscopic mucosectomy state for early gastric cancer (1 case). The average numbers of days to first postoperative oral food intake and hospital stay were 3.1 days and 6.0 days, respectively. There were no postoperative complications.

Laparoscopic wedge resection with handsewn closure should be considered as a valid treatment option for selected gastroduodenal tumors in terms of feasibility, safety, and cost. A more efficient surgical instrument and technique should be developed in future.

The purpose of this study is to prove the safety and efficacy of laparoscopy-assisted subtotal gastrectomy and D2 lymph node dissection using 4 ports and an EEA stapler with a Billroth I anastomosis. From 1999 to 2001, 20 patients with EGC located in the distal stomach underwent laparoscopy-assisted Billroth I gastrectomy (LABIG). A 4-port-technique was performed for omentectomy, vascular ligation, and D2 lymph node dissection. A mini-incision was created between the two ports in the epigastric area and a gastroduodenal anastomosis with an EEA stapler and a distal resection was performed. The mean operating time was 261.8 (170-410) minutes. There was one postoperative complication without any intraoperative transfusions or perioperative mortality. The number of harvested nodes was 31.9 +/- 11.4. Mean distance from the lesion to the margin of resection was 5.3 +/- 2.2 cm proximally and 4.0 +/- 2.0 cm distally. On average, oral liquids were started at the 4.7th (3rd-8th) postoperative day. LABIG is a safe and effective way of performing D2 gastrectomy in terms of morbidity and oncological principles. A randomized controlled clinical study to compare long-term survival and quality of life is warranted.