Endoscopic total layer resection with laparoscopic sentinel node dissection and defect closure for duodenal carcinoid.

Tiny duodenal carcinoid is easily treated by endoscopic mucosal resection method. On the other hand, this tumor develops in the deeper layer of the mucosa, therefore it invades like a submucosal tumor. The resection of the total layer is sometimes needed to get a tumor-free margin. Moreover, lymph node metastasis is not predicted only by tumor size. Laparoscopic surgery is less invasive compared with conventional open surgery. We describe a new method, endoscopic total layer resection with laparoscopic sentinel node dissection and defect closure. This type of combined method should be performed in order to help decide whether to convert to conventional lymph node dissection, or not.