Published online Jun 26, 2021. doi: 10.12998/wjcc.v9.i18.4844
Peer-review started: February 6, 2021
First decision: March 14, 2021
Revised: March 27, 2021
Accepted: April 9, 2021
Article in press: April 9, 2021
Published online: June 26, 2021
Transduodenal local excision is an alternative treatment approach for benign ampullary tumors. However, this procedure has technical difficulties, especially during reconstruction of the pancreaticobiliary ducts. An operating microscope has been widely used by surgeons for delicate surgery due to its major advantages of magnification, illumination, and stereoscopic view. The application of an operating microscope in transduodenal excision of ampullary tumors has not been reported.
A 55-year-old woman was admitted for investigation of recurrent upper abdominal pain. Physical examination and laboratory tests found no abnormalities. Imaging identified a large mass in the descending part of the duodenum. Esophagogastroduodenoscopy revealed a 3.5-cm-sized villous growth over the major duodenal papilla. Pathology of the endoscopic biopsy indicated a villous adenoma with low-grade dysplasia. Microscopic transduodenal excision of the ampullary tumor was performed. The final pathological diagnosis was villous-tubular adenoma with low-grade dysplasia. The patient was discharged on postoperative day 12 after an uneventful recovery. Endoscopic retrograde cholangiopancreatography was performed 3 mo postoperatively and showed no bile duct or pancreatic duct strictures and no tumor recurrence. The patient is continuing follow-up at our clinic and remains well.
Operating microscope-assisted transduodenal local excision is a feasible and effective option for benign ampullary tumors.
Core Tip: Operating microscope-assisted transduodenal excision of ampullary tumors has not been reported. We present our experience of microscopic transduodenal local excision in a case of ampullary adenoma. The application of an operating microscope provides significant technical advantages, particularly in the reconstruction of pancreaticobiliary ducts. The successful outcome in this case suggests that microscopic transduodenal excision is feasible and effective for patients with ampullary tumors.