A Novel Technique for Duodenal Resection and Primary Anastomosis With Robotic Assistance and OrVil

Abstract

Background and objectives: Benign duodenal neoplasm is a rare occurrence. Minimally invasive tumor resection and anastomosis formation with an OrVil catheter is a novel approach to treating this disease. In this article, we present a new technique for duodenojejunal anastomosis. This technique was applied in 4 patients with benign distal duodenal tumors who were treated with minimally invasive surgery with robotic assistance.

Methods: In 4 patients, after the removal of distal duodenal masses with a robotic technique, an orifice in the duodenum was opened to allow for the passage of a guidewire. The guidewire was removed from the orifice by holding it with forceps during an upper endoscopy. An OrVil catheter was sutured to the guidewire outside to allow 2 catheters to proceed consecutively. After the removal of the anvil, an end-lateral duodenojejunostomy was performed with a circular stapler.

Results: The patients included 3 men and 1 woman (average age, 56). The durations of the operations were 215, 175, 180, and 185 minutes. No complications were observed in any of the patients during the postoperative period. The patients began oral intake on the fifth day of the postoperative period, and they were discharged on the sixth postoperative day. Histopathologic analyses indicated that the removed tumors were adenomas in 2 patients and gastrointestinal stromal tumors (GISTs) in 2 patients. Clear surgical margins were observed in all of the patients.

Conclusion: The placement of an OrVil catheter for anastomosis in benign neoplasms with distal duodenum localization and the subsequent achievement of duodenojejunal anastomosis with a circular stapler constitute a novel treatment approach.

Keywords: Duodenal neoplasms; Duodenojejunal anastomosis; OrVil catheter; Robotic resection.

Figure 1.

Intraoperative view of the tumor. A cylinder-like projection toward the abdomen from the duodenal wall.

Figure 2.

Transection of the duodenum and jejunum with a linear stapler and complete resection of the tumor.

Figure 3.

Moving the catheter into the duodenum.

Figure 4.

Removing the catheters from the duodenum: endoscopic catheter first and then the OrVil catheter.

Figure 5.

End-to-lateral duodenojejunal anastomosis formed with a 25-mm circular stapler.

Figure 6.

Circular stapler inserted into the jejunal segment and transected with a linear stapler.