Laparoscopic management of insulinomas

Abstract

Laparoscopic management of insulinomas is feasible and safe. Laparoscopic intraoperative ultrasonography is a promising adjunct to the procedure, even after accurate preoperative localization.

Minimally invasive surgical interventions in the treatment of primary persistent hyperinsulinemic hypoglycemia of infancy

“…Minimally invasive surgical techniques have previously been used in other hyperinsulinemic statuses, like insulinomas (9,10). The medical group chose this technique as a result of the patient's poor drug compliance, which helped him avoid receiving a more invasive intervention than needed.…”

Laparoscopic surgery for pancreatic insulinomas: an update

“…Despite the fact that insulinomas are the most common functional PanNET, they still remain a rare clinical entity and consequently even large volume centers have a limited number of cases that are managed laparoscopically. 51,57,60,62 To our knowledge, no randomized control studies comparing open and laparoscopic management of insulinomas have been performed and are probably unlikely to be performed due to the paucity of cases. The majority of reports that attempt to make direct comparisons are retrospective in nature and therefore have certain limitations.…”

“…61 Since then, numerous highly specialized centers have accrued experience in advanced laparoscopic techniques in pancreatic surgery and in these places most if not all procedures can be completed laparoscopically. 51,57,62,69 Pancreaticoduodenectomy remains a relative exception due to its complexity but is technically feasible in specialized institutions presenting acceptable results compared to open pancreaticoduodenectomy. 70,71 As a result, in high volume centers laparoscopic management has become the mainstay of surgical treatment due to several factors, including shorter length of stay and better cosmetic results.…”

“…Most cases in the literature involve enucleation of solitary lesions in the body or tail of the pancreas and distal pancreatectomy with or without spleen preservation. 51,59,62 A recent meta-analysis of large-scale studies indicated that approximately 65% of laparoscopic procedures completed were enucleations and about 34% distal pancreatectomies, the remainder being pancreaticoduodenectomy and central pancreatectomy. 19 Therefore, here we will focus on enucleation and distal pancreatectomy with or without spleen preservation in patients with sporadic insulinomas.…”

“…57,59,75 Past series have reported successful application of laparoscopic techniques in the management of sporadic insulinomas located especially in the body or tail of the pancreas. 51,60,62,69 Concerns giving rise to debate still persist in the management of solitary lesions located in the head of the pancreas due to complications (up to 64% may develop a fistula) after enucleation. 76,77 A review of the literature indicates that laparoscopic enucleation when employed in selected patients is a technically feasible procedure with comparable complication rates.…”