Duodenal Wedge Resection of Neuroendocrine Tumor Using the Da Vinci SP System Plus One Port: A Video Case Report

Abstract

Background Benign duodenal and periampullary tumors pose surgical challenges due to their proximity to the ampullary complex and gastric outlet. While endoscopic techniques offer minimally invasive options, their efficacy is limited for larger or periampullary lesions1.J Gastroenterol Hepatol. 29:318–324;2.J Neuroendocrinol. 35, ;. Robotic-assisted surgery using the da Vinci SP (Single Port) system may overcome these limitations by offering improved instrument articulation and visualization in confined spaces.

Patient and Method A 66-year-old woman was incidentally found to have a 15 mm mass in the descending duodenum. Endoscopic biopsy confirmed a well-differentiated neuroendocrine tumor. Given the tumor size, surgical resection was planned. For preoperative localization, two endoscopic clips were placed on the lesion the day before surgery. Robotic single-port plus one port (RSP+1) duodenal wedge resection was performed using the da Vinci SP system. After general anesthesia induction and transumbilical trocar placement, an additional 12-mm assistant trocar was inserted in the right upper quadrant. The duodenum was mobilized via Kocher maneuver, and intraoperative endoscopy precisely localized the tumor. Wedge resection was performed, and the defect was closed in two layers.

Results The procedure was completed in 225 min with minimal blood loss. Intraoperative frozen section confirmed negative margins. Final pathology revealed a 1.1 cm, grade 1 well-differentiated neuroendocrine tumor involving the mucosa and submucosa, staged as pT2 per the 8th AJCC classification.3.CA Cancer J Clin 67:93–99 The patient recovered without complications and was discharged on postoperative day 7.

Conclusion Robotic duodenal resection using the da Vinci SP system is a feasible and safe minimally invasive option for selected tumors.