title: Laparoscopic resection of a periampullary villous adenoma.
abstract: BACKGROUND
  Adenomas of the duodenal papilla are rare lesions. Because of their malignant potential, resection is mandatory. Options for resection include endoscopic resection, transduodenal local excision, and pancreaticoduodenectomy. This report details a case of periampullary villous adenoma diagnosed endoscopically and resected laparoscopically via a transduodenal approach.
  
  
  METHODS
  A healthy 75-year-old woman with heartburn underwent an upper endoscopy for vague right upper abdominal pain. A periampullary tumor was diagnosed. Endoscopic biopsy results were consistent with a villous adenoma, and endoscopic ultrasound showed distal bile duct involvement. The patient underwent laparoscopic transduodenal local excision of the tumor with biliary reconstruction.
  
  
  CONCLUSIONS
  Laparoscopic transduodenal resection of periampullary lesions provides advantages similar to those of an endoscopic resection by removal of the tumor using minimally invasive techniques. In addition, laparoscopic surgery maintains the surgical tenents of open transduodenal resection with en bloc tumor resection including the adjacent duodenal wall and ductal structures as necessary. As noted in this case, laparoscopic techniques resect ampullary lesions involving the ductal structures as well. Laparoscopic transduodenal ampullectomy is a valuable treatment option for benign and selected premalignant ampullary lesions.
authors.affiliation: Minimally Invasive Surgery Center, Department of General Surgery, Cleveland Clinic Foundation, 9500 Euclid Avenue, Building A-80, Cleveland OH 44195, USA.
authors.forename: M
authors.initials: M
authors.lastname: Rosen
authors.forename: G
authors.initials: G
authors.lastname: Zuccaro
authors.forename: F
authors.initials: F
authors.lastname: Brody
mesh_terms: D018253:Adenoma, Villous / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000601:surgery*; D000368:Aged; D014670:Ampulla of Vater; D000714:Anastomosis, Surgical; D001652:Bile Ducts / Q000601:surgery; D002760:Cholangiopancreatography, Endoscopic Retrograde; D017081:Cholecystectomy, Laparoscopic; D002769:Cholelithiasis / Q000150:complications / Q000601:surgery; D003138:Common Bile Duct Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000601:surgery*; D004210:Dissection / Q000295:instrumentation / Q000379:methods; D016145:Endoscopy, Digestive System; D019160:Endosonography; D005260:Female; D006356:Heartburn / Q000150:complications; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D014464:Ultrasonic Therapy; D018084:Ultrasonography, Interventional