title: Hybrid resection of duodenal tumors.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of Surgical Oncology, Stanford University School of Medicine, Stanford, California 94305-5641, USA. gpoultsides@stanford.edu
authors.forename: George A
authors.initials: GA
authors.lastname: Poultsides
authors.forename: Emmanouil P
authors.initials: EP
authors.lastname: Pappou
authors.forename: George Peter
authors.initials: GP
authors.lastname: Bloom
authors.forename: Rocco
authors.initials: R
authors.lastname: Orlando
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004379:Duodenal Neoplasms / Q000601:surgery*; D005260:Female; D058733:Hand-Assisted Laparoscopy; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies