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Thirty non-ampullary cases treated between November 2016 and August 2024 underwent full-thickness suture reinforcement after ESD. Median operation time/bleeding differed by approach: 281 min/10 mL for anterior and 297 min/0 mL for transmesocolic. Delayed perforation or other postoperative complications were not observed, with curative resection achieved and no recurrences during a median 35-month follow-up.",{"@graph":69,"@context":123},[70,84,106],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/anterior-and-transmesocolic-approaches-for-duodenal-laparoscopic-and-endoscopic-cooperative-surgery/376302/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/anterior-and-transmesocolic-approaches-for-duodenal-laparoscopic-and-endoscopic-cooperative-surgery/376302.png","ImageObject",300,407,{"name":92,"@type":93},"Aldword","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-29","2026-09-24",true,{"@type":102,"interactionType":103,"userInteractionCount":105},"InteractionCounter",{"@type":104},"ViewAction",12,{"@type":107,"mainEntity":108},"FAQPage",[109,115,119],{"name":110,"@type":111,"acceptedAnswer":112},"What clinical problem does D-LECS aim to address for duodenal laparoscopic procedures?","Question",{"text":113,"@type":114},"Extensive dissection needed for the second and third portions of the duodenum complicates laparoscopic surgery. D-LECS provides reinforcement of the ESD site after the procedure to prevent delayed leakage.","Answer",{"name":116,"@type":111,"acceptedAnswer":117},"How were anterior and transmesocolic approaches selected in this study?",{"text":118,"@type":114},"The anterior approach was used for tumors in the first to upper second portion of the duodenum, while the transmesocolic approach was used for tumors in the second to third portions.",{"name":120,"@type":111,"acceptedAnswer":121},"What were the key perioperative and follow-up outcomes reported?",{"text":122,"@type":114},"Median operation time and bleeding were lower for transmesocolic approach bleeding (0 mL) compared with anterior approach (10 mL). No postoperative complications such as delayed perforation were observed, and curative resection was achieved with no recurrence during a median 35-month follow-up.","https://schema.org",{"og:url":83,"og:type":125,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":127,"canonical":83},"index,follow",{"doc_id":129,"site_id":62},376302,1790488904,{"code":4,"msg":5,"data":132},{"doc_id":129,"user_id":133,"nickname":92,"user_avatar":134,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":105,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":39,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":46},2336478940917,"https://ap-avatar.wpscdn.com/davatar_6f874abed73319feea01a86fa6f0fab8","[www. nature.com/scientificreports](www. nature.com/scientificreports)  \nOPEN  \nAnterior and transmesocolic approaches for duodenal laparoscopic and endoscopic cooperative surgery  \nDaisuke Matsushita1􀀍, Takaaki Arigami1, Fumisato Sasaki2, Hidehito Maeda2, Masataka Shimonosono1, Keishi Ohkubo1, Yusuke Tsuruda1, Ken Sasaki1, Shigehiro Yanagita3, Yoshikazu Uenosono4 & Takao Otsuka1  \nThe Kocher maneuver is the most common surgical approach for duodenal tumors. However, the extensive dissection required for the second and third portions ofthe duodenum complicates laparoscopic procedures. This study introduces the anterior and transmesocolic approaches in laparoscopic and endoscopic cooperative surgery for duodenal neoplasms (D-LECS). Thirty patients who underwent D-LECS at our institute between November 2016 and August 2024 were included. The median age was 62.5 years, and the median pathological tumor size was 15 mm. Tumors were located in the first, second, and third portions ofthe duodenum in 5, 20, and 5 patients, respectively. The anterior approach was performed in the first to upper second portion of the duodenum in seven patients; the transmesocolic approach was performed in the second to third portions ofthe duodenum in 23 patients. All patients underwent full-thickness suture reinforcement after endoscopic submucosal dissection. The median operation time and bleeding volume were 281 min and 10 mL, respectively, for the anterior approach and 297 min and 0 mL, respectively, for the transmesocolic approach. Postoperative complications, such as delayed perforation, were not observed. All patients underwent curative resection. Pathological analyses revealed 21, 7, 1, and 1 case of adenoma, adenocarcinoma, gastrointestinal tumor, and neuroendocrine tumor, respectively. Disease recurrence was not observed during the follow-up (median, 35 months) . D-LECS using the anterior and transmesocolic approaches based on tumor location may allow for individualized surgical management in patients with early duodenal neoplasms.  \nDuodenal cancer is rare, with reported incidences of 2.9–4.3 per 1,000,000 person-years in Western countries1,2 and 23.7 per 1,000,000 person-years in Japan3. Moreover, duodenal gastrointestinal stromal tumors (GIST) are extremely rare, accounting for 5% of all GISTs in Japan; the incidence of all GISTs is 1–2 per 100,000 personyears4. Pancreaticoduodenectomy after chemotherapy is the standard treatment strategy for advanced duodenal cancers, including Vater’s ampulla tumors. Although minimally invasive techniques, such as laparoscopic surgery and endoscopic submucosal dissection (ESD), have been developed for digestive system tumors, the efficacy of these modalities for duodenal neoplasms remains unclear. Several studies have demonstrated the clinical utility of endoscopic mucosal resection (EMR) and ESD for duodenal neoplasms5. However, the risk of severe complications, such as intraoperative and delayed perforation caused by severe peritonitis, should be noted6,7. Considering the risks associated with ESD, laparoscopic partial resection may be a safer approach with good oncological curability. However, this procedure often results in unnecessary excision of the duodenal wall, which can cause duodenal constriction and obstruction. Hiki et al.8,9 reported laparoscopic and endoscopic cooperative surgery (LECS) for GIST, termed LECS for duodenal tumors (D-LECS), which enables reinforcement of the ESD site immediately after the procedure to prevent delayed leakage. Although several studies have corroborated the safety and feasibility of D-LECS10–12 details regarding the surgical procedures for D-LECS remain controversial. In several studies, the Kocher maneuver was performed to expose the ESD site; however, this approach sometimes  \n1Department of Digestive Surgery, Kagoshima University, Sakuragaoka 8-35-1, Kagoshima city 890-8520, Kagoshima, Japan. 2Department of Digestive and Lifestyle Diseases, Kagoshima Universi","cbCaiqcm75ruxy5H","https://ap.wps.com/l/cbCaiqcm75ruxy5H","pdf",1886646,"English","# Methods\n## Patients\n## Operative procedures\n## Patient position\n## Laparoscopic preparation\n## ESD procedure","[{\"question\":\"What clinical problem does D-LECS aim to address for duodenal laparoscopic procedures?\",\"answer\":\"Extensive dissection needed for the second and third portions of the duodenum complicates laparoscopic surgery. D-LECS provides reinforcement of the ESD site after the procedure to prevent delayed leakage.\"},{\"question\":\"How were anterior and transmesocolic approaches selected in this study?\",\"answer\":\"The anterior approach was used for tumors in the first to upper second portion of the duodenum, while the transmesocolic approach was used for tumors in the second to third portions.\"},{\"question\":\"What were the key perioperative and follow-up outcomes reported?\",\"answer\":\"Median operation time and bleeding were lower for transmesocolic approach bleeding (0 mL) compared with anterior approach (10 mL). No postoperative complications such as delayed perforation were observed, and curative resection was achieved with no recurrence during a median 35-month follow-up.\"}]","Anterior and transmesocolic approaches for duodenal laparoscopic and endoscopic cooperative surgery | PDF",1790218134]