Dr. Eric Herrero

Laparoscopic transduodenal ampullectomy for ampullar tumor

Transduodenal ampullectomy was first introduced by Halstead in 1899 as the treatment for ampulla of Vater cancer, but the technique was not stardardized. Whipple’s duodenopancreatectomy has been the gold standard surgical procedure for ampulla of Vater lesions, whereas transduodenal ampullectomy has been reported in limited cases and with no consensus regarding its indications. Recently, endoscopic papillectomy has also been considered for ampulla of Vater tumor resection, but some cases are not suitable for this option and inadequate margins or false negative results for malignancy require further procedures and close follow-up. Transduodenal ampulkctomy is attempted as an initial treatment in patients with ampulla of Vater tumors with no evidence of malignancy on preoperative tests. The operative procedure can be performed laparoscopically and includes a Kocher maneuver, a longitudinal duodenotomy and a full-thickness excision of the ampulla. The reconstructive phase includes a re-implantation of both the common bile duct and the pancreatic duct. Cholecystectomy is performed routinely. An intraoperative pathological exam can determine whether duodenopancreatectomy is necessary. In conclusion, transduodenal ampullectomy can be considered an intermediate step between endoscopic papillectomy and pancreaticoduodenectomy for the treatment of ampulla of Vater tumors, making it possible to prevent unnecessary major resections. In this video, Dr. Herrero and Dr. Cugat perform a laparoscopic transduodenal ampullectomy for the excision of a solid tumor in the ampulla of Vater.