Minimally invasive surgery for resection of duodenal carcinoid tumors: endoscopic full-thickness resection under laparoscopic observation.
BACKGROUND
Carcinoid tumors of the duodenum are rare, and the most effective treatment for duodenal carcinoid tumors remains debatable. Because carcinoid tumors of the gastrointestinal tract tend to spread to the submucosal layer even during the early stages of the disease, the possibility of tumor seeding in the vertical margin of the tumor cannot be eliminated by conventional endoscopic mucosal resection (EMR). In addition, because the duodenal wall is thinner than the gastric wall, EMR performed for duodenal lesions may be associated with a high risk of accidental perforation. In this article, we introduce a minimally invasive endoscopic full-thickness resection technique after laparoscopic repair for the local resection of duodenal carcinoid tumors.


METHODS
Under general anesthesia, after the duodenum was mobilized laparoscopically, the duodenal serosa at the site of the lesion was suctioned under laparoscopic observation, and full-thickness resection of the duodenum was performed using a cap-fitted endoscope, i.e., EMR-c, without injecting hypertonic saline-epinephrine. The sample was retrieved endoscopically after resection. After confirming that the full-thickness resection of the duodenal wall with enough surgical margins was achieved and that there was no active bleeding, the wound was sutured by the laparoscopic hand-suturing technique.


RESULTS
We have performed this surgical procedure in two cases of duodenal carcinoid tumor. The mean operation time was 116 +/- 14 minutes, and the estimated blood loss was 2.5 +/- 0.5 ml. The postoperative courses were uneventful in both cases.


CONCLUSIONS
The technique of endoscopic full-thickness resection of gastrointestinal tract under laparoscopic observation is a safe, simple, and can be radical surgical procedure for a small duodenal carcinoid tumor. This surgical procedure may be applicable in the case of other gastrointestinal tumors.
Tsujimoto
Hironori
H
Department of Surgery, National Defense Medical College, Namiki, Tokorozawa, Japan. tsujihi@ndmc.ac.jp
Ichikura
Takashi
T
Nagao
Shigeaki
S
Sato
Tomoki
T
Ono
Satoshi
S
Aiko
Satoshi
S
Hiraki
Shuichi
S
Yaguchi
Yoshihisa
Y
Sakamoto
Naoko
N
Tanimizu
Takemaru
T
Yamamoto
Junji
J
Hase
Kazuo
K
D000368:Aged; D016063:Blood Loss, Surgical; D002276:Carcinoid Tumor / Q000601:surgery*; D004379:Duodenal Neoplasms / Q000601:surgery*; D020698:Duodenoscopes; D004384:Duodenoscopy / Q000379:methods*; D004867:Equipment Design; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011028:Pneumoperitoneum, Artificial; D013536:Suture Techniques