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Ielpo B, Vellalta G, Jaume-Boettcher SM, d'Addetta MV, Sanchez-Velazquez P, Burdio F. Transduodenal robotic ampullectomy: tips and tricks and strategies for postoperative duodenal fistula management (with video). Updates Surg 2024:10.1007/s13304-024-01808-4. [PMID: 38507177 DOI: 10.1007/s13304-024-01808-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Accepted: 02/25/2024] [Indexed: 03/22/2024]
Abstract
Transduodenal Ampullectomy (TA) is a procedure for resecting low-malignancy ampullary tumors, with postoperative fistula as a notable complication. This study aims to clarify the indications for TA, outline the surgical robotic technique, and emphasize the importance of comprehensive complication management alongside the surgical approach. This multimedia article provides a detailed exposition of the robotic TA surgical technique, including the most important steps involved in exposing and reimplanting biliary and pancreatic ducts. The procedure encompasses the mobilization of the hepatic flexure of the colon, an extensive Kocher maneuver for duodenal mobilization, and ampulla exposure through a duodenal incision. Employing retraction loop sutures enhances surgical field visibility. Reconstruction involves securing pancreatic and biliary ducts to the duodenal mucosa, each tutored with a silicon catheter, and suturing for ampullectomy completion. The total operative time was 380 min. Final histopathology disclosed high-grade dysplasia with an isolated focus of adenocarcinoma (pT1), accompanied by clear resection margins. A postoperative duodenal fistula occurred, managed successfully through conservative treatment, utilizing subcutaneous drainage. Despite accurate robotic TA execution, complications may arise. This study underscores the importance of a comprehensive approach, incorporating meticulous surgical technique and effective complication management, to optimize patient outcomes.
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Affiliation(s)
- Benedetto Ielpo
- HPB Unit, Pompeu Fabra University, Parc Salut Mar University Hospital, Passeig Maritim, 25, 08003, Barcelona, Spain.
| | - Gemma Vellalta
- HPB Unit, Pompeu Fabra University, Parc Salut Mar University Hospital, Passeig Maritim, 25, 08003, Barcelona, Spain
| | - Sofia-Maria Jaume-Boettcher
- HPB Unit, Pompeu Fabra University, Parc Salut Mar University Hospital, Passeig Maritim, 25, 08003, Barcelona, Spain
| | - Maria Vittoria d'Addetta
- HPB Unit, Pompeu Fabra University, Parc Salut Mar University Hospital, Passeig Maritim, 25, 08003, Barcelona, Spain
| | - Patricia Sanchez-Velazquez
- HPB Unit, Pompeu Fabra University, Parc Salut Mar University Hospital, Passeig Maritim, 25, 08003, Barcelona, Spain
| | - Fernando Burdio
- HPB Unit, Pompeu Fabra University, Parc Salut Mar University Hospital, Passeig Maritim, 25, 08003, Barcelona, Spain
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Fernández Aceñero MJ, Martínez Useros J, Díez-Valladares L, Ortega-Medina L, Pérez Aguirre E, de la Serna Esteban S, García Botella S, Díaz Del Arco C. [Prognostic factors in adenocarcinoma of the ampulla of Vater]. Rev Esp Patol 2018; 51:210-215. [PMID: 30269771 DOI: 10.1016/j.patol.2018.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 02/26/2018] [Accepted: 03/07/2018] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Ampullary adenocarcinoma seems less aggressive than other pancreato-biliary neoplasms. The aim of this study is to define determining prognostic factors. MATERIAL AND METHODS Retrospective case series from a large tertiary Hospital including all patients diagnosed with ampullary adenocarcinoma who underwent cephalic pancreatoduodenectomy with curative intent. Outcome variables have been progression free survival and overall survival. RESULTS 24 patients were included. 54.2% were females and the mean age was 72.5 (45-85). Most cases were of intestinal type (50%), followed by pancreatobiliary (37.5%) and mucinous. Only 8.3% were high histopathological grade. Vessel invasion was detected in 31.8% of the cases and perineural infiltration in 20.8%. A large percentage of cases showed no lymph node involvement at the time of diagnosis (54.1%). Most cases were stage T1 or T3 (39.1 y 43.5%, respectively). 34.8% of the patients recurred, mainly in regional lymph nodes (62.5% of the recurrences) and they all died of tumor, mainly during the first year after diagnosis. Multivariate analysis with Cox regression model revealed that only lymph node involvement was independently associated to a shorter disease free progression interval and overall survival. CONCLUSIONS Lymph node involvement was the most important predictive factor for ampullary adenocarcinoma in this series.
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Affiliation(s)
- M Jesús Fernández Aceñero
- Departamentos de Anatomía Patológica y Cirugía General, Hospital Clínico San Carlos, Madrid, España; Unidad de Oncología Fundación Jiménez Díaz, Madrid, España.
| | | | - Luis Díez-Valladares
- Departamentos de Anatomía Patológica y Cirugía General, Hospital Clínico San Carlos, Madrid, España
| | - Luis Ortega-Medina
- Departamentos de Anatomía Patológica y Cirugía General, Hospital Clínico San Carlos, Madrid, España
| | - Elia Pérez Aguirre
- Departamentos de Anatomía Patológica y Cirugía General, Hospital Clínico San Carlos, Madrid, España
| | | | - Sandra García Botella
- Departamentos de Anatomía Patológica y Cirugía General, Hospital Clínico San Carlos, Madrid, España
| | - Cristina Díaz Del Arco
- Departamentos de Anatomía Patológica y Cirugía General, Hospital Clínico San Carlos, Madrid, España
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Sabater Ortí L, Martín-Pérez E, Artigas Raventós V. The origins of oncological pancreatic surgery in Spain. A tribute to pioneers. Cir Esp 2017; 95:190-198. [PMID: 28238362 DOI: 10.1016/j.ciresp.2017.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 12/22/2016] [Accepted: 01/07/2017] [Indexed: 11/28/2022]
Abstract
Pancreaticoduodenectomy (PD) is a very complex operation. Its development took place very slowly at the most prestigious centers in the world. The aim of this investigation is to know who were the first surgeons to perform a PD in Spain as well as its historical circumstances. Despite all kinds of difficulties and very few resources, the first PD in Spain were carried out in Barcelona at the Hospital de la Santa Creu i Sant Pau where from the mid-50s a school of gastrointestinal surgery emerged with surgeons soon to become the spearhead of the Spanish surgery and a reference for the whole country: Pi-Figueras, Vicente Artigas, Antonio Soler-Roig and Antonio Llauradó. Almost simultaneously, in Oviedo, Luis Estrada also introduced the PD and total pancreaticoduodenectomy after a period of training with the pioneers of pancreatic surgery in the United States.
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Affiliation(s)
- Luis Sabater Ortí
- Departamento de Cirugía,Hospital Clínico, Universitat de Valencia, Valencia, España.
| | | | - Vicens Artigas Raventós
- Departamento de Cirugía, Hospital de la Santa Creu i Sant Pau, Universitat Autónoma de Barcelona, Barcelona, España
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Abstract
Endoscopic ultrasound (EUS) provides relevant information when an ampullary or periampullary tumor is suspected. Early detection, T and N staging and Fine Needle Aspiration plus cithologic confirmation, are some of the expected benefits. Exclusion of benign findings like choledocholithiasis or chronic pancreatitis is also important. A correct understanding of the complex ampullary and periampullary anatomy is needed. Knowledge of the individual clinical history and other previous diagnostic images all contribute to a successful EUS examination. Radial and lineal EUS images are uniquely detailed and, at the moment, it seems to be the best way to exclude or confirm malignant or benign findings. We propose a procedural algorithm, including EUS, for suspected ampullary or periampullary tumors. This review summarizes the vast amount of information to be found spread in the literature, and recognizes this small anatomic area as the origin for a clinical entity with proper clinical presentation, proper imaging and proper therapeutic resolutions. The benefits of performing EUS for its study are highlighted.
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Affiliation(s)
- Cecilia Castillo
- Cecilia Castillo, Endoscopy Service, Latin American Endoscopy Training Center, Clínica Alemana de Santiago, Universidad del Desarrollo, Vitacura 5951, Santiago, Chile
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