Robotic transduodenal ampullectomy: an alternative surgical technique for benign tumors at the ampulla of Vater.

Periampullary tumors are rare lesions that originate in a complex anatomical region including the ampulla of Vater, the distal common bile duct (CBD), the second portion of the duodenum, the head of pancreas, and the pancreatic duct (PD). Tumors of the ampulla of Vater are distinct from other cancers of the duodenum, the CBD, and the pancreas in that they are distal to the confluence of the CBD and the PD. These lesions may be benign or malignant, and the mainstay treatment is excision. Endoscopic resection, open transduodenal ampullectomy, and pancreaticoduodenectomy have been historic options for the treatment of the benign tumors at the ampulla of Vater. Adoption of minimally invasive transduodenal ampullectomy via laparoscopy remained limited due to the complex surgical anatomy of the ampulla of Vater. As minimally invasive hepato-pancreato-biliary procedures are becoming more common due to better visualization and improved patient outcomes, novel approaches to treatment for benign diseases are being developed. With recent advancements of minimally invasive surgery via robotics, technical challenges due to complex surgical anatomy could be mitigated. This paper presents a novel approach of robotic transduodenal ampullectomy as an acceptable treatment option for benign tumors at the ampulla of Vater using submucosal injection of Eleview® blue viscous solution.