title: A novel combined laparoscopic-endoscopic cooperative approach for duodenal lesions.
abstract: OBJECTIVE
  A surgical approach with minimal invasion and excellent outcome for removal of duodenal lesions, using laparoscopic-endoscopic cooperative surgery (LECS), was established.
  
  
  METHODS
  Two patients underwent the resection of duodenal lesions with our novel LECS approach. Case 1 (age: 49 years; male) had a 20-mm 0-IIa-like lesion (group IV tumor on biopsy) in the duodenal bulb. LECS interventions, performed under general anesthesia, employed a total of four trocars. The extent of lesions was determined with the endoscopic submucosal dissection (ESD) technique. The affected duodenal wall was then perforated before a one fifth turn resection was performed to expose lesions of the whole layer. A tumor, confirmed under laparoscopy, was turned over toward the abdominal cavity to facilitate resection. Case 2 (age: 49 years; female) had 20-mm 0-IIc lesions (group III adenoma) located at the second portion of the duodenum. LECS procedures for duodenal resection were performed in a manner similar to case 1 . A total of five trocars were used.
  
  
  RESULTS
  Histologic diagnosis of the tumor in case 1 was tubular adenoma with moderate atypia (size: 20 x 12 mm). As for case 2, histopathologic findings confirmed a tubular adenoma with moderate atypia (size: 18 x 18 mm) and an adenoma-negative surgical margin. The postoperative courses, in both cases, were uneventful.
  
  
  CONCLUSIONS
  Although only 2 cases were surgically intervened with limited experience, the present novel LECS approach allowed a reliable, adequate resection of tumors located in the duodenum, with abbreviated operation times (156-179 versus 202-229 minutes), minimal bleeding, less postoperative stress imposed on the surgeons, and an uneventful postoperative course, compared to conventional surgical methods.
authors.affiliation: Department of Surgery, Nagano Municipal Hospital, Nagano, Japan. sakon@shinshu-u.ac.jp
authors.forename: Masahiro
authors.initials: M
authors.lastname: Sakon
authors.forename: Manabu
authors.initials: M
authors.lastname: Takata
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Seki
authors.forename: Ken
authors.initials: K
authors.lastname: Hayashi
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Munakata
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Tateiwa
mesh_terms: D000236:Adenoma / Q000601:surgery*; D004379:Duodenal Neoplasms / Q000601:surgery*; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged