Abstract
Introduction:
An 83-year-old female was discovered to have an incidental circumferential duodenal adenoma by upper endoscopy after being evaluated for irritable bowel syndrome. Imaging revealed a dilated common bile duct and main pancreatic duct but no evidence of malignancy. Therefore, she was considered a candidate for surgical removal.
Methods and Materials:
Using robotic-assisted surgery, a 4 trocar approach was employed involving three 8-mm and one 12-mm robotic trocar apart. 1 A standard cholecystectomy followed by careful dissection of the duodenum from the pancreas head was performed. The ampulla was identified, and the duodenum was laterally retracted with transection of the identified ampulla with exposure of the pancreaticobiliary orifice. A two-layered duct to mucosa pancreaticobiliary anastomosis was established between the common bile, pancreatic duct, and the jejunum. A side-to-side stapled gastrojejunostomy was constructed and the operation concluded. 2,3
Results:
Pathological analysis revealed a noninvasive polypoid lesion within the duodenum measuring 7.5 × 5.0 × 0.6 cm. The surgery was completed in 350 minutes with blood loss of 100 mL. There were no postop complications, and the patient was discharged on the fifth day. The patient had some gastric symptoms post discharge which subsided with time.
Conclusions:
This case highlights the feasibility and safety of robotic resection for an obstructing duodenal polyp in complex anatomical regions, demonstrating its clinical utility and relevance for the management of benign ampullary duodenal lesions.
Patient Consent Statement:
The patient who was operated upon issued consent for operative data to be used for publication, under Mayo Clinic, Jacksonville, signed consent forms.
The author(s) have received and archived patient consent for video recording/publication in advance of video recording of procedure.
Conflict of Interests:
This article is not under consideration by any other journal, and all authors have approved the article. None of the authors have any competing financial interests.
Runtime of video:
9 minutes and 33 seconds.