Ann Hepatobiliary Pancreat Surg.  2021 Feb;25(1):150-154. 10.14701/ahbps.2021.25.1.150.

Robotic transduodenal ampullectomy: Case report and review of the literature

• Linn YL
• Wang Z
• Goh BKP

• KMID: 2513190
• DOI: http://doi.org/10.14701/ahbps.2021.25.1.150

Abstract

Ampullary neoplasms are relatively uncommon lesions with a risk of progression to malignancy. Depending on its nature, size and location, it may be best treated with endoscopic papillotomy, pancreaticoduodenectomy or transduodenal ampullectomy. Transduodenal ampullectomy offers a higher chance of complete resection compared to endoscopic papillotomy, and carries lower morbidity than a pancreaticoduodenectomy, making it the ideal choice for localised ampullary tumour not involving the ducts but not amenable to complete endoscopic resection. While traditionally performed via open surgery, it has been attempted via laparoscopic approach and more recently robotic approach. We present a case of a 63-year-old man who underwent a robotic transduodenal ampullectomy for ampullary adenoma with high grade dysplasia, and review the literature surrounding robotic transduodenal ampullectomy.

Keyword

Ampullary neoplasm; Transduodenal ampullectomy; Robotic surgery; Minimally invasive surgery

Figure

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  Fig. 1 MRCP showing dilated bile duct with cutoff at the obstructing ampullary mass.

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  Fig. 2 Positioning of robotic ports.

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  Fig. 3 Longitudinal duodenotomy over ampulla.

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  Fig. 4 Identification of common bile duct and main pancreatic duct.

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  Fig. 5 Suturing of pancreatic duct orifice with aid of internal stent.

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  Fig. 6 Post reconstruction of main pancreatic duct and common bile duct.

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  Fig. 7 Closure of duodenotomy with vicryl.

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