title: Robotic surgery for benign duodenal tumors.
abstract: BACKGROUND
  Benign duodenal and periampullary tumors are uncommon lesions requiring careful attention to their complex anatomic relationships with the major and minor papillae as well as the gastric outlet during surgical intervention. While endoscopy is less morbid than open resection, many lesions are not amenable to endoscopic removal. Robotic surgery offers technical advantages above traditional laparoscopy, and we demonstrate the safety and feasibility of this approach for a variety of duodenal lesions.
  
  
  METHODS
  We performed a retrospective review of all robotic duodenal resections between April 2010 and December 2013 from two institutions. Demographic, clinicopathologic, and operative details were recorded with special attention to the post-operative course.
  
  
  RESULTS
  Twenty-six patients underwent robotic duodenal resection for a variety of diagnoses. The majority (88 %) were symptomatic at presentation. Nine patients underwent transduodenal ampullectomy, seven patients underwent duodenal resection, six patients underwent transduodenal resection of a mass, and four patients underwent segmental duodenal resection. Median operative time was 4 h with a median estimated blood loss of 50 cm(3) and no conversions to an open operation. The rate of major Clavien-Dindo grades 3-4 complications was 15 % at post-operative days 30 and 90 without mortality. Final pathology demonstrated a median tumor size of 2.9 cm with a final histologic diagnoses of adenoma (n = 13), neuroendocrine tumor (n = 6), gastrointestinal stromal tumor (GIST) (n = 2), lipoma (n = 2), Brunner's gland hamartoma (n = 1), leiomyoma (n = 1), and gangliocytic paraganglioma (n = 1).
  
  
  CONCLUSIONS
  Robotic duodenal resection is safe and feasible for benign and premalignant duodenal tumors not amenable to endoscopic resection.
authors.affiliation: Division of Surgical Oncology, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Downs-Canner
authors.forename: Wald J
authors.initials: WJ
authors.lastname: Van der Vliet
authors.forename: Stijn J J
authors.initials: SJ
authors.lastname: Thoolen
authors.forename: Brian A
authors.initials: BA
authors.lastname: Boone
authors.forename: Amer H
authors.initials: AH
authors.lastname: Zureikat
authors.forename: Melissa E
authors.initials: ME
authors.lastname: Hogg
authors.forename: David L
authors.initials: DL
authors.lastname: Bartlett
authors.forename: Mark P
authors.initials: MP
authors.lastname: Callery
authors.forename: Tara S
authors.initials: TS
authors.lastname: Kent
authors.forename: Herbert J
authors.initials: HJ
authors.lastname: Zeh
authors.forename: A James
authors.initials: AJ
authors.lastname: Moser
mesh_terms: D000236:Adenoma / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical; D004379:Duodenal Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D046152:Gastrointestinal Stromal Tumors / Q000601:surgery*; D006222:Hamartoma / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects; D007889:Leiomyoma / Q000601:surgery*; D008067:Lipoma / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D018358:Neuroendocrine Tumors / Q000601:surgery*; D061646:Operative Time; D010235:Paraganglioma / Q000601:surgery*; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000009:adverse effects