closure of the duodenotomy unless there is a concern about the integrity of the clo­sure or concern over narrowing of the duodenum.

In general, patients have favorable outcomes after both transduodenal wedge resec­tion and ampullectomy, regardless of open or minimally invasive technique. Given the rarity of these tumors and resections, data for each operation is sparse and incon­sistent. There are several retrospective, single-center studies describing outcomes after open transduodenal resection. Most of these operations appear to take between 2 and 4h and have minimal blood loss (50–100mL). Length of stay, when reported, is typically well over 1 week and the 90-day mortality rate in recent literature approaches zero. Given the technical challenges associated with laparoscopic trans­duodenal resections, only case reports and small case series appear in the literature. Despite similar blood loss to the open procedure, operative times are an hour longer on average and length of stay is closer to 1week. Nienty-day mortality is also zero for these cases. Since robotic surgery is the newest technique, it is also most often documented as case reports. Robotic-assisted cases appear to have shorter operative times and decreased length of stay compared to open and laparoscopic data though without an appreciable difference in overall mortality, morbidity, or recurrence. More studies are needed to parse out differences in the minimally invasive com­pared to open techniques, especially as robotic surgery becomes more prevalent.