ArticleAnnals of surgical oncology2025
Defining Precision Surgery: Totally Laparoscopic Transduodenal Ampullectomy : A Combined Approach Aims for Margin Resection Success.
Article in Annals of surgical oncology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
introductionAdenomas are premalignant lesions of the ampulla of Vater and should therefore be resected. PATIENT AND
methodsA 64-year-old female patient, following an episode of acute pancreatitis, was diagnosed with a lesion of the ampulla of Vater. An endoultrasound-guided biopsy revealed an ampullary adenoma with low-grade dysplasia. Its growth along the duct made it not amenable for endoscopic resection. Consequently, a laparoscopic ampullectomy was then proposed. To obtain optimal free margins, a combined strategy was designed: the use of a choledochoscope (allowing for a direct view of the lesion limits), intraoperative ultrasound (to rule out possible intramural tumor growth), and indocyanine green (used to identify the bile duct and also in the filling of a Fogarty Catheter
resultsOperative time was 416 min. The postoperative course was uneventful, and the patient was discharged on the fifth postoperative day. Pathology reported a well-demarcated ampullary adenoma with low-grade dysplasia and free margins. Twenty-four months after surgery, the patient is asymptomatic with no evidence of recurrence.
conclusionsTransduodenal minimally invasive ampullectomy is a demanding procedure. The combined use of technologies herein presented warrants a precision surgery allowing for a free-margin anatomical resection.
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