Ultrasound-guided Laparoscopic Resection of Pancreatic Islet Cell Tumors

Abstract

Pancreatic islet cell tumors represent a diverse group of neuroendocrine lesions. These tumors may be singular or multiple, benign or malignant, sporadic, or part of the constellation of multiple endocrine neoplasia type 1. Tumors such as insulinomas and gastrinomas produce gastrointestinal peptides that lead to diagnosis. Nonfunctioning lesions may be found incidentally or by screening patients at high risk for such tumors. Successful management of patients with pancreatic islet cell tumors relies on accurate localization and sound operative technique. With proper preoperative localization, advanced laparoscopic methods can be used to manage patients with these pancreatic neoplasms. Preoperative localization of pancreatic islet cell tumors was difficult in the past. Standard imaging and localizing modalities, such as computed tomography scanning, magnetic resonance imaging, angiography, transabdominal sonography, and portal venous sampling, yield only 24% to 75% accuracy. Consequently, many biochemically suspected lesions cannot be imaged with current techniques. Decreased tactile sensation of laparoscopy adds complexity to intraoperative identification. Endoscopic sonography and laparoscopic sonography provide accurate preoperative and intraoperative localization to enhance laparoscopic and open resection. The authors treated two patients with islet cell neoplasms using endoscopic sonography to preoperatively visualize the tumors and laparoscopic sonography to guide laparoscopic enucleation. Their approach and difficulties are discussed.

Occult sporadic insulinoma: Localization and surgical strategy

“…It also defines the relationship of the tumor to the mesenteric vessels and confirms the adequacy of resection. Additionally, it readily demonstrates the relevant operative anatomy, defining the relationship of the tumor to the pancreatic and bile duct, and adjacent blood vessels [49][50][51][52] .…”

Comparison of Clinical Outcomes of Single Incision versus Conventional Multi-Port Laparoscopic Distal Pancreatectomy: A Single Institution Experience

“…[17] Ultrasonography is also a useful modality for localizing small lesions intraoperatively. [17][18][19] Such lesions, which are small and distant from the pancreatic duct, can be removed with enucleation and the tumors that are localized in the distal part of the pancreas can be removed with SILS pancreatectomy. [16] In our case series, we routinely benefited from intraoperative ultrasonography as well.…”

Treatment of a non-typical hepatic pseudolesion complicated by greatly elevated alpha fetoprotein: case report and literature review

“…In the case presented here, the hepatic pseudolesion was missed by non-invasive ultrasound but finally found by intraoperative ultrasonography. Intraoperative ultrasonography is more sensitive than non-invasive ultrasound, but it is limited because it is more invasive [13]. A negative result from non-invasive ultrasonography did not result in a final diagnosis but did suggest the possibility of hepatic pseudolesion.…”