Laparoscopy-assisted transduodenal papillectomy: how we do it (with video)

Background: Some authors previously reported that early ampulla of Vater neoplasms have a low potential of lymph node metastasis and favorable prognosis and, therefore, could be indicated for limited resections instead of the standard pancreatoduodenectomy (PD). In limited resections, when compared to endoscopic papillectomy, transduodenal papillectomy is less technically demanding and a sufficient surgical margin can be achieved due to the greater extent of the excisional area. This didactic video article demonstrated our standardized laparoscopy-assisted transduodenal papillectomy (LATDP). Methods: The technique consisted of 3 steps: laparoscopic Kocher mobilization, papillectomy, and reconstruction. This laparoscopy-assisted approach was more favorable than the pure laparoscopic approach as there was no tumor exposure in the abdominal cavity, which might potentially lead to intraabdominal tumor dissemination. Results: Our LATDP served as a total biopsy to decide whether the subsequent PD was inevitable to patients with early ampulla of Vater neoplasms. Conclusion: This procedure provides the benefit of minimal invasiveness and oncological safety. Therefore, it should be considered as an option in the armamentarium of modern pancreatic and biliary tract surgeries.