Laparoscopic Resection of a Para-aortic Tumor Located On The Descending Part Of The Duodenum

We present a patient diacnosed with duodenal tumor that was laparoscopically excised by Dr. Lucian Mocan at 3-rd Surgery Clinic (Clinica Chirurgie 3) Cluj Napoca, Romania/
A 64-year-old woman presented to the gastroenterology clinic with a few-week-old history of recurrent right-upper quadrant pain and elevated liver enzymes. The pain occurred after meals but was unrelated to medication and was not associated with nausea or vomiting. She did not smoke or drink alcohol.
The patient had no known allergies and was not taking any regular medication. Family and social history were unremarkable. General physical examination revealed a young and otherwise healthy woman with normal body mass index and vital signs, eliciting no abnormal findings.
Routine blood tests (full blood count, C-reactive protein, urea and electrolytes, thyroid function tests, liver function tests) were notable for a γ-glutamyltransferase level of 75 U/l (7-36 U/l.
Computed tomography showed a 2/3 cm tumor mass located on the D2 region in contact with the anterior wall of the aorta. In adition multiple biliary lithisis was noticed.
The duodenoscopy reveled an external compression at the descending level of duodenum.
A laparoscopy was planned. Under general anesthesia the patient was put in the supine position.
After creation of pneumoperitoneum and placement of the optical trocar in the supraumbilical region, a 12-mm trocar was inserted on the pararectal line at the left lower quadrant and two 5-mm trocars at the right upper quadrant just below the costal margin on the anterior axillary line and medioclavicular line respectively.