Partial duodenectomy with seromyotomy by the "lift-and-cut" method for superficial nonampullary duodenal epithelial tumors: A novel technique

Abstract

Introduction: The therapeutic strategy for superficial nonampullary duodenal epithelial tumors remains controversial. We developed a novel surgical technique for superficial nonampullary duodenal epithelial tumors. We report the initial two cases managed with this method.

Materials and surgical technique: We endoscopically confirmed the tumor location and circumferentially incised the seromuscular layer of the duodenum along it. After circumferential seromyotomy, the submucosal layer was expanded by endoscopic insufflation, and the target lesion was sufficiently lifted. The submucosal layer, including the target lesion, was stapled and resected after confirming the absence of problems with endoscopic passage. The seromuscular layer was continuously sutured to bury and reinforce the stapler line. Single-incision laparoscopic surgery was performed in one case. The resected specimens measured 52 × 32 mm and 50 × 26 mm with negative surgical margins. Both patients were discharged without complications and demonstrated no evidence of stenosis.

Discussion: Compared with previously reported procedures, this method of partial duodenectomy with seromyotomy for superficial nonampullary duodenal epithelial tumors is promising, simple, and safe.

Keywords: endoscopic submucosal dissection; laparoscopic and endoscopic cooperative surgery; partial duodenectomy with seromyotomy.