Robotic-assisted transduodenal ampullectomy for a neuroendocrine tumour: A step-by-step surgical video

IF 2.1 4区医学 Q3 ONCOLOGY

Surgical Oncology-Oxford Pub Date : 2026-12-01 Epub Date: 2026-10-12 DOI:10.1016/j.suronc.2026.102585

Gianluca Rompianesi, Giuseppe Kito Fusai

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引用次数: 0

Abstract

Background

When endoscopic resection of ampullary neuroendocrine tumors (NETs) is not feasible due to tumour size or location, transduodenal ampullectomy can offer a parenchymal-sparing alternative to a formal pancreaticoduodenectomy (Whipple procedure) [1], [2]. We present a robotic-assisted transduodenal ampullectomy (RATA) in a 71-year-old male with an incidental 14 mm ampullary NET found during routine screening. Preoperative ⁶⁸Ga-DOTATATE PET-CT demonstrated intense somatostatin-receptor avidity (SUVmax 66.8) and absent FDG uptake. The MDT recommended surgical excision due to size and Ki-67 4%.

Methods

Following right colonic flexure mobilisation and a Kocher maneuver, the cystic duct was isolated and cannulated with a 4 Fr catheter to guide biliary identification. After a longitudinal duodenotomy, the ampullary lesion was visualized. Submucosal saline-adrenaline was injected in the submucosal plane. Diathermy scissors were used to perform a circumferential mucosal and muscularis dissection. Biliary and pancreatic ducts were sharply divided and reconstructed using interrupted 5/0 polydioxanone sutures between the pancreatobiliary ducts and the duodenal mucosa after positioning a 6 Fr catheter in the pancreatic duct. The duodenotomy was closed in two layers using a 4/0 absorbable barbed suture, and a methylene blue leak test through the nasogastric tube confirmed duodenal integrity.

Results

The procedure was completed successfully with no intraoperative complications. A postoperative contrast-enhanced CT on day 5 demonstrated no collections and no oral contrast extravasation. Oral feeding was gradually reintroduced, the abdominal drain was removed, and the patient was discharged on day 7. Following a brief readmission on day 13 for a pulmonary microembolism successfully treated with medical therapy, the patient recovered fully and remains disease-free 7 months after surgery.

Conclusion

RATA can represent a safe, feasible, and pancreas-preserving alternative to formal pancreaticoduodenectomy for well-differentiated ampullary NETs in selected patients. The robotic platform enhances three-dimensional visualization and wrist articulation, optimizing the delicate micro-reconstruction of the pancreaticobiliary junction.

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机器人辅助经十二指肠壶胃切除术治疗神经内分泌肿瘤：一步一步的手术视频。

背景：当壶腹神经内分泌肿瘤（NETs）因肿瘤的大小或位置而无法内镜切除时，经十二指肠壶腹切除术可作为保留实质的胰十二指肠切除术（Whipple手术）的替代选择[1,2]。我们提出了一个机器人辅助的经十二指肠壶腹切除术（RATA）在一个71岁的男性偶然发现14毫米壶腹网常规筛查。术前68Ga-DOTATATE PET-CT显示强烈的生长抑素受体贪婪（SUVmax 66.8）和FDG摄取缺失。MDT建议手术切除，因为尺寸和Ki-67 4%。方法：在右结肠屈曲活动和Kocher手法下，分离胆囊管并用4fr导管插管以指导胆道识别。纵向十二指肠切开术后，可见壶腹病变。粘膜下平面注射盐肾上腺素。使用透热剪刀进行环周粘膜和肌肉层解剖。在胰管内置入6 Fr导管后，采用胰管与十二指肠黏膜间中断的5/0聚二恶酮缝合线对胆管和胰管进行快速分割和重建。采用4/0可吸收的有刺缝线将十二指肠切开术分两层闭合，并通过鼻胃管进行亚甲蓝漏检，证实十二指肠完整性。结果：手术顺利完成，无术中并发症。术后第5天的对比增强CT显示无积液和口腔造影剂外渗。逐渐恢复口服喂养，移除腹腔引流管，患者于第7天出院。经药物治疗成功后，患者于第13天短暂再次入院，手术后7个月完全恢复，无疾病。结论：在选定的患者中，对于分化良好的壶腹部NETs， RATA是一种安全、可行、保留胰腺的替代方法，可替代正式胰十二指肠切除术。该机器人平台增强了三维可视化和手腕关节，优化了胰胆管连接处的精细显微重建。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Surgical Oncology-Oxford 医学-外科

CiteScore

4.50

自引率

0.00%

发文量

169

审稿时长

38 days

期刊介绍： Surgical Oncology is a peer reviewed journal publishing review articles that contribute to the advancement of knowledge in surgical oncology and related fields of interest. Articles represent a spectrum of current technology in oncology research as well as those concerning clinical trials, surgical technique, methods of investigation and patient evaluation. Surgical Oncology publishes comprehensive Reviews that examine individual topics in considerable detail, in addition to editorials and commentaries which focus on selected papers. The journal also publishes special issues which explore topics of interest to surgical oncologists in great detail - outlining recent advancements and providing readers with the most up to date information.