title: Laparoscopic and endoscopic cooperative surgery for duodenal neuroendocrine tumor (NET) G1: Report of a case.
abstract: BACKGROUND
  We report a case of duodenal neuroendocrine tumor (NET) G1 resected by laparoscopic and endoscopic cooperative surgery (LECS) technique.
  
  
  METHODS
  A 58-year-old woman underwent esophagastroduodenoscopy, revealing an 8-mm, gently rising tumor distal to the pylorus, on the anterior wall of the duodenal bulb. Endoscopic ultrasonography suggested the tumor might invade the submucosal layer. The tumor was pathologically diagnosed as a G1 duodenal NET, by biopsy. Endoscopic submucosal dissection was attempted, but was unsuccessful because of the difficulty of endoscopically performing an inversion operation in the narrow working space. The case was further complicated by the patient's duodenal ulcer scar. We performed a full-thickness local excision using laparoscopic and endoscopic cooperative surgery. The tumor was confirmed and endoscopically marked along the resection line. After full-thickness excision, using endoscopy and laparoscopy, interrupted full-thickness closure was performed laparoscopically.
  
  
  CONCLUSIONS
  Endoscopic treatment is generally recommended for G1 NETs <10mm in diameter and extending only to the submucosal layer. However, some cases are difficult to resect endoscopically because the wall of duodenum is thinner than that of stomach, and endoscope maneuverability is limited within the narrow working space. LECS is appropriate for early duodenal G1 NETs because they are less invasive and resection of the lesion area is possible.
  
  
  CONCLUSIONS
  We demonstrated that LECS is a safe and feasible procedure for duodenal G1 NETs in the anterior wall of the first portion of the duodenum.
authors.affiliation: Ehime Rosai Hospital, Department of Surgery, Minamikomatsubara-cho 13-27, Niihama, Ehime 792-8550, Japan. Electronic address: ttsushimi@yahoo.co.jp.
authors.forename: Takaaki
authors.initials: T
authors.lastname: Tsushimi
authors.affiliation: Ehime Rosai Hospital, Department of Surgery, Minamikomatsubara-cho 13-27, Niihama, Ehime 792-8550, Japan.
authors.forename: Hirohito
authors.initials: H
authors.lastname: Mori
authors.affiliation: Ehime Rosai Hospital, Department of Surgery, Minamikomatsubara-cho 13-27, Niihama, Ehime 792-8550, Japan.
authors.forename: Takasuke
authors.initials: T
authors.lastname: Harada
authors.affiliation: Ehime Rosai Hospital, Department of Surgery, Minamikomatsubara-cho 13-27, Niihama, Ehime 792-8550, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Nagase
authors.affiliation: Ehime Rosai Hospital, Department of Surgery, Minamikomatsubara-cho 13-27, Niihama, Ehime 792-8550, Japan.
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Iked
authors.affiliation: Ehime Rosai Hospital, Department of Pathology, Minamikomatsubara-cho 13-27, Niihama, Ehime 792-8550, Japan.
authors.forename: Hiromo
authors.initials: H
authors.lastname: Ohnishi
keywords: Carcinoid; Duodenal NET G1; Laparoscopic and endoscopic cooperative surgery (LECS)