Robotic duodenal sleeve resection: The transmesenteric approach

Abstract

Objective: Duodenal surgery can be challenging, particularly involving the second through forth portions. Considerations include its' deep retroperitoneal location, adjacent vascular structures, and cognizance of the Ampulla of Vater. In this presentation, we describe a novel approach to the performance of a robotic duodenal sleeve resection for an adenoma just distal to the Ampulla. Duodenal exposure, dissection, and resection are performed through a mesocolic window right of the middle colic vessels with concomitant placement of common bile duct stent to aid in the visualization of the ampulla. A side-to-side anastomosis is then performed through this window. This elegant technique can become a useful component of a hepatobiliary surgeon's armamentarium.