title: A Novel Technique for Duodenal Resection and Primary Anastomosis With Robotic Assistance and OrVil.
abstract: OBJECTIVE
  Benign duodenal neoplasm is a rare occurrence. Minimally invasive tumor resection and anastomosis formation with an OrVil catheter is a novel approach to treating this disease. In this article, we present a new technique for duodenojejunal anastomosis. This technique was applied in 4 patients with benign distal duodenal tumors who were treated with minimally invasive surgery with robotic assistance.
  
  
  METHODS
  In 4 patients, after the removal of distal duodenal masses with a robotic technique, an orifice in the duodenum was opened to allow for the passage of a guidewire. The guidewire was removed from the orifice by holding it with forceps during an upper endoscopy. An OrVil catheter was sutured to the guidewire outside to allow 2 catheters to proceed consecutively. After the removal of the anvil, an end-lateral duodenojejunostomy was performed with a circular stapler.
  
  
  RESULTS
  The patients included 3 men and 1 woman (average age, 56). The durations of the operations were 215, 175, 180, and 185 minutes. No complications were observed in any of the patients during the postoperative period. The patients began oral intake on the fifth day of the postoperative period, and they were discharged on the sixth postoperative day. Histopathologic analyses indicated that the removed tumors were adenomas in 2 patients and gastrointestinal stromal tumors (GISTs) in 2 patients. Clear surgical margins were observed in all of the patients.
  
  
  CONCLUSIONS
  The placement of an OrVil catheter for anastomosis in benign neoplasms with distal duodenum localization and the subsequent achievement of duodenojejunal anastomosis with a circular stapler constitute a novel treatment approach.
authors.affiliation: Department of General Surgery.
authors.forename: Abdulkadir
authors.initials: A
authors.lastname: Bedirli
authors.affiliation: Department of General Surgery.
authors.forename: Bulent
authors.initials: B
authors.lastname: Salman
authors.affiliation: Department of General Surgery.
authors.forename: Mahir
authors.initials: M
authors.lastname: Nasirov
authors.affiliation: Department of Gastroenterology, Gazi University Medical Faculty, Ankara, Turkey.
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Dogan
mesh_terms: D000236:Adenoma / Q000601:surgery; D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000295:instrumentation* / Q000379:methods*; D057785:Catheters; D004379:Duodenal Neoplasms / Q000601:surgery*; D004386:Duodenum / Q000601:surgery; D005260:Female; D046152:Gastrointestinal Stromal Tumors / Q000601:surgery; D006801:Humans; D007582:Jejunostomy; D008297:Male; D008875:Middle Aged; D065287:Robotic Surgical Procedures; D017792:Surgical Stapling
keywords: Duodenal neoplasms; Duodenojejunal anastomosis; OrVil catheter; Robotic resection