PubMed · 13707561
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M C GOVOSTIS. 1961. Hemorrhoidectomy.. https://doi.org/10.1016/s0039-6109(16)36295-8
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The key issue in the field of therapeutic endoscopy in recent years is the development of a new therapeutic strategy for early gastric cancers using endoscopic submucosal dissection (ESD) technique. ESD was developed to overcome the problem of remnant or recurrent tumors after incomplete resection by conventional endscopic mucosal resection (EMR). Ever since after the emergence of ESD, indication criteria for endoscopic resection of early gastric cancers were extended through expansion of both theoretical and technical conditions. Complete en bloc resection rates were 96.7% and 62.6% in the ESD group and the EMR group, respectively, in our institution. ESD is a highly effective technique enabling us to resect much larger and difficult lesions, which cannot be resected by conventional EMR techniques. However, it involves a much higher complication rate and requires much higher skills. A small lesion less than 20 mm located in a good position can be resected completely, without any difficulties using conventional EMR techniques. Therefore, we must consider the approach to treatment, when conducting an endoscopic resection,it terms of the situation and skills of the endoscopist.
BACKGROUND: Benign duodenal tumours are rare and less common than malignant tumours. They comprise a wide variety of pathologies. Schwannoma is an ectodermal neoplasm arising from the nerve sheath that envelops axons. A duodenal location is extremely rare. Therapy consists in the radical excision of the tumour. Our aim was to describe a minimally invasive technique used for the excision of duodenal schwannoma, so that a laparotomy has been avoided. METHODS: A laparoscopic operation under general anaesthesia was undertaken with the patient in supine position with the legs abducted. No macroscopic peritoneal seedling was found. Therefore, a laparoscopic Kocher maneuver was performed. The retroperitoneum was entered using the harmonic scalpel and the dissection extended beyond the vena cava and the duodenum. The location and the size of the lesion have been confirmed using an intraoperative endoscopic ultrasound examination. The excision of the lesion was performed by use the harmonic scalpel. Then, the duodenal wall was sutured by use endoscopic stitches. The resected lesion was then placed in a retrieval bag and extracted through the port incision. Operating time was 300 min and blood loss 200 ml. RESULTS: The postoperative course was uneventful. Histological findings showed a benign schwannoma. CONCLUSIONS: The minimally invasive technique may be a valid alternative to open surgery in the treatment of benign duodenal tumors.