Accurate localization of an insulinoma by preoperative selective intra-arterial calcium injection and intraoperative glucose monitoring

Iwanaka, Tadashi; Matsumoto, Masatomo; Yoshikawa, Yoshinobu; Koda, Naoya; Mochizuki, Hidetaka; Aihara, Toshinori; Imaizumi, Satoshiko

doi:10.1007/s003830050036

Cited by 6 publications

(3 citation statements)

References 5 publications

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“…[ 16 ] and Iwanaka et al . [ 17 ] also in their study have reported similar result. Junginger et al .…”

Section: Discussionsupporting

confidence: 76%

Laparoscopic surgery for solitary insulinoma in the absence of IOUS

Dalvi¹,

Garale²,

Takalkar³

et al. 2018

J Min Access Surg

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Background:Insulinomas are the most common pancreatic neuroendocrine neoplasms. In spite of adequate pre-operative localisation, conventional surgical methods rely on intraoperative palpation. Intraoperative ultrasonography (IOUS) is said to aid in accurate localisation, decreases morbidity. Laparoscopic removal of pancreatic endocrine neoplasms is beneficial due to magnification and minimal invasion; however, in the absence of IOUS, error of judgement may lead to conversion to open surgery, thereby relying on ‘palpation method’ to localise the tumour. We combined laparoscopic surgical removal of insulinomas using an innovative method of ‘laparoscopic finger palpation’ with intraoperative blood glucose monitoring and frozen section for surgical cure.Materials and Methods:Patients were evaluated and investigated by the department of endocrinology and referred for surgical management of insulinoma. Pre-operative localisation of insulinoma was done by either contrast-enhanced computerised tomography angiogram – arterial and venous phase, or endoscopic ultrasound (EUS) or DOTATATE scan. Intraoperative localisation was done by laparoscopic dissection and ‘laparoscopic finger palpation’. After enucleation, the specimen was sent for frozen section, and in the interim period, serial monitoring of blood glucose was done by the anaesthetist. Maintenance of glucose levels for more than 45 min after enucleation and confirmation of neuroendocrine tumour on frozen section was the end point of surgical procedure.Results:A total of 19 patients were subjected to laparoscopic removal of solitary insulinomas. Enucleation was performed in 16 patients successfully. In three patients, laparoscopic distal pancreatectomy was performed. Three patients had pancreatic duct leak, of which two patients responded to conservative approach and the third patient required drainage by USG-guided pigtail catheter. All patients are cured of their disease and no patient has had recurrence so far.Conclusion:Multidisciplinary approach involving laparoscopic palpation, frozen sections and intraoperative blood sugar monitoring helps laparoscopic management of solitary insulinomas without IOUS.

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“…[ 16 ] and Iwanaka et al . [ 17 ] also in their study have reported similar result. Junginger et al .…”

Section: Discussionsupporting

confidence: 76%

Laparoscopic surgery for solitary insulinoma in the absence of IOUS

Dalvi¹,

Garale²,

Takalkar³

et al. 2018

J Min Access Surg

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“…Several studies have proposed confirming complete resection of insulinoma intraoperatively such as by a quick IRI assay and intraoperative blood glucose measurement [ 10–12 ]. However, other studies reported no increase in the IRI level in some cases.…”

Section: Discussionmentioning

confidence: 99%

Intraoperative selective arterial calcium injection test to confirm complete resection of a proinsulinoma

Sakamoto

Ogawa

Iwata

et al. 2022

Journal of Surgical Case Reports

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Proinsulinoma is a subtype of insulinoma that is surgically curable, but localization can be difficult as these tumors are typically too small to be visualized by imaging. We report the case of a 53-year-old woman referred to our hospital with dizziness and headache. Her blood glucose level was 46 mg/dl and Whipple’s triad was present. Although her immunoreactive insulin level during hypoglycemia was in the normal range (5.0 μU/ml), the proinsulin level was elevated (408 pmol/l). Imaging examinations showed no evidence of pancreatic tumor. A preoperative selective arterial calcium injection (SACI) test showed excessive insulin secretion in the splenic artery region, which localized the proinsulinoma to the body or tail of the pancreas, and laparoscopic spleen-preserving distal pancreatectomy was performed. Intraoperative SACI test performed after tumor removal did not show excessive insulin secretion. The intraoperative SACI test appears to be useful for localization and for confirming complete resection of proinsulinoma.

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“…A localização tumoral é realizada por meio da ultrassonografia transabdominal, tomografia computadorizada ou imagem de ressonância magnética, as quais são limitadas, pois falham na detecção de insulinomas menores que 1cm de diâmetro [36,37]. A laparoscopia com ultrassonografia intraoperatória, associada à palpação do pâncreas, apresenta sensibilidade >85% na detecção tumoral [38].…”

Section: Tumores Neuroendócrinos Pancreáticos (Tnps)unclassified

Estudo molecular dos componentes da via de sinalização HGF/MET em insulinomas

Murat¹

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Accurate localization of an insulinoma by preoperative selective intra-arterial calcium injection and intraoperative glucose monitoring

Cited by 6 publications

References 5 publications

Laparoscopic surgery for solitary insulinoma in the absence of IOUS

Laparoscopic surgery for solitary insulinoma in the absence of IOUS

Intraoperative selective arterial calcium injection test to confirm complete resection of a proinsulinoma

Estudo molecular dos componentes da via de sinalização HGF/MET em insulinomas

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