PMC7691666_01
A 30-mm laterally spreading tumor and a diverticulum in the periampullary area.
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An upper endoscopy detected a 30-mm wide, laterally spreading tumor (LST), with a diverticulum in the periampullary area; part of the tumor was red (Fig. 1).
Port placement schema.
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The laparoscope was introduced, and four additional 5-mm ports were introduced in the right and left subcostal margins, along the right anterior axial line, and in the supraumbilical area (shown in Fig. 2).
a) A Shuriken-shaped skin incision is created. b) A mini-laparotomy is performed through Shuriken-shaped skin incision.
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A Shuriken-shaped umbilical skin incision (6-cm wide, 4-cm long, with a 3-cm diameter center) was made and the skin removed (shown in Fig. 3a). The upper abdominal fascia was exposed, and an 8-cm upper abdominal mini-laparotomy was performed (Fig. 3b).
The common channel (blue arrow) and the diverticulum (white arrow) were identified under direct vision.
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The common channel and parapapillary duodenal diverticulum were also confirmed (Fig. 4).
Postoperative skin scars.
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Post-operatively, only a 3-cm round scar around the umbilicus and the four port scars remained (Fig. 5).