Laparoscopic enucleation of an insulinoma of the pancreas tail

A 29 year-old woman with a tumor of the pancreatic tail was referred to our institute. The tumor was confirmed to be a solitary benign insulinoma that protruded from the pancreas and was distant from the main pancreatic duct. A laparoscopic enucleation was performed with Laparoscopic Coagulating Shears (LCS). The postoperative course was uneventful. The laparoscopic enucleation for benign pancreatic tumor was thought to be a feasible procedure when the appropriate instruments were used.     

腹腔镜保留脾脏的胰体尾切除术治疗胰岛素瘤1例报道及文献复习

目的:探讨完全腹腔镜保留脾脏的胰体尾切除术(laparoscopic spleen-preserving distal pancreatectomy,LSPDP)治疗胰体尾部胰岛素瘤的可行性、安全性及诊疗技巧,总结全腹腔镜下胰岛素瘤的诊断与治疗经验。方法:2014年8月1日为1例胰岛素瘤患者施行LSPDP,复习相关文献并总结其主要环节。结果:手术在全腹腔镜下完成,手术顺利,手术时间210 min,术中出血量200 ml。术中放置引流管,术后第7天拔除。血糖监测提示手术效果满意,症状完全缓解,无胰漏及其他并发症发生,术后第11天出院,随访至今未见肿瘤复发。结论:位于胰体尾部的胰岛素瘤行LSPDP是微创、安全的,具有创伤小、康复快、并发症少等优点。对于改善预后、术后快速恢复等方面具有重要意义,可作为胰体尾良性、交界性肿瘤的首选术式。     

Laparoscopic resection of ectopic pancreas in the gastric antrum: case report and literature review

We report a case of ectopic pancreas tissue in the gastric wall that was removed using a minimally invasive approach. The patient was a 46-year-old obese woman who presented with fatigue, weakness, abdominal discomfort, and guaiac-positive stools. Laboratory analysis showed iron deficiency anemia. Preoperative endoscopy revealed a submucosal lesion in the gastric antrum. Intraoperative upper endoscopy clearly located the lesion at the antrum. The lesion was marked with India ink, allowing it to be identified easily at laparoscopy. A laparoscopic wedge resection of the gastric antrum was performed. The patient had an uneventful recovery. We believe that this is a valid treatment option for this benign condition.     

Laparoscopic vasectomy: case report and review of the literature

A 42-year-old man undergoing bilateral laparoscopic hernia repair requested vasectomy for family planning purposes. Bilateral vasectomy was done by a laparoscopic approach at the time of extraperitoneal hernia repair, and a separate scrotal incision was avoided. In addition to reporting a case of laparoscopic vasectomy, we review the published literature on this topic.     

Laparoscopic enucleation of a pancreatic insulinoma

Insulinoma is the most common functional neuroendocrine tumor of the pancreas [2]. In most cases the lesions are benign, solitary, and located within the pancreatic parenchyma. Because of these characteristics, the majority of these lesions can be treated with simple enucleation [2]. Advances in laparoscopic techniques have recently enabled the safe resection of pancreatic islet cell tumors [1] and may provide patients with the benefits of minimally invasive surgery. This video demonstrates the technique of laparoscopic enucleation of a pancreatic insulinoma. The case presentation is that of a 40-year-old man who had symptoms of neuroglycopenia and was found to have elevated proinsulin levels during a 72-hour fast. Further evaluation included a CT scan, which revealed a 1.5 cm lesion on the posterior surface of the midbody of the pancreas. The video shows the operative technique of enucleation of the lesion, including positioning and trocar placement, performance of intraoperative ultrasound for tumor localization, and the use of specialized instruments (laparoscopic freer-elevator with a spatulated tip) that allowed enucleation of the lesion without excess handling of the tumor itself. The operation was performed in 105 minutes with minimal blood loss. The patient was fed clear liquid diet on the day after surgery and was discharged home on the third postoperative day. He had an uneventful recovery and has experienced no further symptoms. This multimedia article (video) has been published online and is available for viewing at http://www.springerlink.com. Its abstract is presented here. As a subscriber to Surgical Endoscopy you have access to our SpringerLink electronic service, including Online First.     

Solid-pseudopapillary tumors of the pancreas: case report and literature review

Solid pseudopapillary tumors (SPT) of the pancreas are rare neoplasms of low malignant potential that mostly affect young women. These tumors are of unclear pathogenesis, are slow growing, and can become considerably large before causing symptoms. Complete resection is curative in most cases. This is the case of a 39-year-old African-American woman undergoing evaluation for Roux-en-Y gastric bypass, who was found to have a pancreatic mass. Image-guided biopsy revealed SPT. The patient underwent complete excision of the tumor and had an open Roux-en-Y gastric bypass performed concurrently. The patient had an uneventful postoperative course. A review of the literature is presented.     

Sarcoidosis of the pancreas: case report and review of the literature

Sarcoidosis involving the pancreas is rare. Patients can present with symptoms that mimic pancreatic cancer. We report a case of a male patient with clinical and radiographic findings suggestive of pancreatic cancer as the initial manifestation of sarcoidosis.     

Laparoscopic enucleation of a solitary pancreatic insulinoma

Insulinomas are usually small, benign tumors of the pancreas, often found in obese patients, which require an incision that is out of all proportion to the size of the lesion. A laparoscopic technique for enucleation of a pancreatic insulinoma is described. Received: 4 October 1994/Accepted: 18 September 1995     

胰腺多形性未分化肉瘤：病例报告与文献回顾

背景与目的:多形性未分化肉瘤(UPS),既往称为恶性纤维组织细胞瘤(MFH)是一种间叶源性恶性肿瘤,占所有软组织肉瘤的20%以上,多发生于四肢、躯干及腹膜后。发生于胰腺的UPS极为罕见。国内、外虽有报道,但多以个案形式报道,缺少大宗病例资料分析。本研究就笔者团队诊治的1例胰腺UPS患者,结合文献,探讨其临床特点、诊疗及预后。方法:回顾分析内蒙古医科大学附属医院肝胆外科诊治的1例胰腺UPS患者的临床资料,同时检索国内外数据库中的相关文献资料,将同类病例资料汇总分析。结果:共32例(笔者单位1例加文献报告病例31例)纳入研究,其中男20例,女12例;中位年龄54.6(22~74)岁。按病理类型分为:巨细胞型9例,黏液型5例,多形性型18例;按发生部位分为:胰头13例,胰体尾12例,胰体3例,胰尾2例,全胰腺2例。术前诊断为胰腺癌8例,胰腺肿物及占位6例,假性囊肿4例,囊腺瘤4例,胰腺肿瘤3例,间质肿瘤1例,纤维肉瘤1例,炎性病变1例,未提及术前诊断4例。临床表现大多表现为快速软组织肿块进行性增大,常伴有压迫症状,可伴有恶心呕吐,上腹部不适、腹胀,体质量减轻或黄疸。所有患者的术前诊断中无正确诊断。32例均行手术治疗,围术期死亡1例,总生存期15.3个月。结论:胰腺UPS为高度恶性肿瘤,无明显特异性临床表现,极易发生转移及复发,预后差。早期、完整切除肿瘤以获得R0切除是手术治疗的核心,但是由于胰腺UPS的特殊组织生物学行为,在部分病例中即使施行广泛切除或根治性切除,仍不能避免肿瘤局部复发或远处转移。术后给予放化疗有可能能够改善患者的生存。     

Lymphoepithelial cyst in the pancreas: a case report and review of the literature

BACKGROUND: Lymphoepithelial cysts of the pancreas constitute a rare clinicopathologic entity. CASE REPORT: We report a case of lymphoepithelial cyst of the pancreas and review the world literature. RESULTS: Lymphoepithelial cysts are true pancreatic cysts lined by squamous epithelium and surrounded by mature lymphoid tissue. The cyst arises typically in middle aged men, and is usually asymptomatic or causes nonspecific abdominal complaints. There is no specific serologic marker for this entity. None of its radiologic characteristics can help differentiate it from other cystic lesions of the pancreas. Fine-needle aspiration cytology may be able to suggest its benign nature and identify it as a true cyst of the pancreas. The outcome after surgical excision is uniformly good with good symptom control and no recurrences. RECOMMENDATIONS: In the symptomatic patient or the asymptomatic patient with acceptable surgical risk a simple cyst excision should be performed after verification of the diagnosis with frozen section. In the asymptomatic patient with a high surgical risk, in whom fine-needle aspiration suggests the diagnosis of a lymphoepithelial cyst, observation of the lesion is recommended. When simple cyst excision is technically not possible, extensive resections/reconstructions should be avoided and drainage/bypass procedures may be considered.     

Solid pseudo papillary tumor of the pancreas: case report and literature review

Solid pseudopapillary neoplasm (SPT) of the pancreas is a rare exocrine tumor, for the first time described from Frantz et al. in 1959. Despite the increasing recognition of the tumor in this last year, its pathogenesis remain unclear. It occurs predominantly in young woman and behave in an indolent fashion, even when distant metastasis are present. The Authors report the case of a 24 years-old woman with an abdominal mass localized in retro-peritoneum, removed with body-tail of the pancreas and spleen, diagnosed as pancreatic SPT after histological examination.     

胰腺混合性腺泡- 神经内分泌癌1例报道及文献复习

目的:探讨胰腺混合性腺泡-神经内分泌癌(MANEC)的临床病理特征、鉴别诊断和治疗方法。方法:回顾性分析收治的1例胰腺MANEC患者的临床资料,结合国内外文献,总结该病的临床特点、病理特征、鉴别诊断和治疗方法。结果:该患者术前影像学检查提示十二指肠降部肿瘤,行手术治疗,术后病理提示胰腺MANEC。术后患者顺利出院,20个月后复查CT提示肿瘤无复发转移。结论:胰腺MANEC是非常罕见的肿瘤,常无典型的症状,最终需要病理确诊。预后至今不清楚,但是早期的手术治疗能显著提高总的生存期。     

Laparoscopic treatment of adrenal myelolipoma: case report and review of the literature

Adrenal myelolipoma is a rare benign, non-functioning tumor consisting of fat and hematopoietic tissues. In January 2005 we had observed an adrenal myelolipoma in 70 year old man. During the follow-up for bladder urothelioma, an abdominal CT revaled a well delineated 4x4 cm homogeneous fatty mass in the right suprarenal area with negative attenuation values. The functional study of adrenal gland was normal. The patient underwent videolaparoscopic right adrenalectomy (Gagner technique). Postoperative course was uneventful. The istological diagnosis showed adrenal myelolipoma. We conclude that videolaparoscopic adrenalectomy should be considered the gold standard treatment for benign adrenal lesions.     

以囊性胰岛素瘤为主的多发性内分泌腺瘤病1型：病例报道与文献回顾

目的 通过研究笔者团队诊治的1例以囊性胰岛素瘤为主的多发性内分泌腺瘤病1型（multiple endocrine neoplasia type 1,MEN1）,结合文献,探讨MEN1的临床特点、诊疗及预后。方法 回顾性分析内蒙古医科大学附属医院肝胆外科诊治的1例MEN1的临床资料;同时在万方数据库以“多发性内分泌腺瘤病1型”和“胰岛素瘤”为检索词,在Pubmed以“multiple endocrine neoplasia type 1”与“insulinoma”为检索词进行检索,对诊断为胰岛素瘤且有影像学资料提示囊、实性胰腺占位的病例资料汇总分析。结果本组病例共有24例患者纳入分析,其中男11例,女13例,年龄8～55岁。所有患者中,囊性或囊实性患者5例：1例为多发,肿瘤位于胰体、胰尾;其余4例为单发,肿瘤分别位于胰体、胰尾;实性患者19例：8例为多发,11例为单发,钩突、胰头、胰体、胰尾均有肿瘤分布。24例中有18例行手术切除肿瘤治疗,1例药物治疗（二氮嗪）,1例行超声引导下无水乙醇消融术,1例经动脉注射聚苯乙烯-马来酸偶联新卡津抑素,1例因胰岛素瘤术后复发行球形聚乙烯醇颗粒栓塞治疗,2例患者未治疗。治疗的22例恢复良好,未治疗的2例死亡,其中1例因肿瘤无法切除行对症治疗,2个月后死于进行性肾功能衰竭,另1例未手术数月后死亡。有随访记录的患者12例,随访期间均存活,有1例患者术后复发,再次手术后恢复良好。结论 MEN1是一种常染色体显性遗传疾病,以囊性或者囊实性胰岛素瘤为表现者较少,容易漏诊和误诊。综合分析临床资料,合理运用基因检测辅以手术等适宜干预措施对MEN1诊疗和预后具有重要意义。     

Laparoscopic splenopexy for wandering spleen: case report and review of the literature

Wandering spleen is a rare condition in which the spleen lacks retroperitoneal fixation, thus its vascular pedicle can twist resulting in ischemia. Although splenectomy has traditionally been used for this condition, splenopexy is increasingly used in the pediatric population to anchor the spleen and preserve splenic function. We report an unusual case of wandering spleen in an adult with chronic torsion managed with laparoscopic splenopexy, suggesting splenic preservation is possible in adults with this presentation as well.     

Laparoscopic radical nephrectomy during pregnancy: case report and review of the literature

Routine ultrasonography revealed a large, complex renal mass in a 39-year-old pregnant woman. An MRI confirmed a 14.5 x 12 x 17 cm complex renal mass, and laparoscopic nephrectomy was chosen as the management option. During the mid-second trimester, a right laparoscopic nephrectomy was performed. The pathology report noted clear-cell carcinoma with negative margins. The child, delivered without incident, is now more than 2 years old and is developmentally normal. A review of laparoscopy in pregnancy is also presented.     

Laparoscopic management of gallstone ileus: A case report and literature review

Introduction and importanceGallstone ileus is an uncommon complication of cholelithiasis. It is usually presented as a small bowel obstruction. Elderly patients are commonly affected. The diagnosis is challenging, since needs a high index of suspicion and imagenology is key. Surgery is the mainstay management, most commonly performed by laparotomy, but laparoscopy is summing cases. Nevertheless the approach is still controversial. We report a gallstone ileus case, that was managed totally laparoscopic in our medium complex public institution.Case presentationAn 71 years-old male patient, with symptomatic cholelithiasis, consulted in emergency department with symptoms and signs of small bowel obstruction. Computed tomography of abdomen and pelvis showed the classical Rigler's triad. Totally laparoscopic enterolithotomy alone was performed successfully. Postoperative evolution was without incidents, being discharge at fifth day.Clinical discussionGallstone ileus represents around 0,3–0,5% of cholelithiasis complications. Mostly affect elderly women patients, with comorbidities. Mortality and morbidity is still high nowadays. The classical management of gallstone ileus is the open surgery, but the laparoscopic approach has been described and it can be done.ConclusionThe laparoscopic management of gallstone ileus is effective and secure procedure and seems reasonable to attempt if the conditions and skills are available.     

Laparoscopic resection of the pancreas and review of the literature

BACKGROUND: Laparoscopic pancreatic surgery still is not a common procedure worldwide. Postoperative complications such as a pancreatic leakage cause a serious condition. We report our consecutive laparoscopic pancreatic resections of islet cell tumors or benign diseases and their outcomes. METHOD: Laparoscopic pancreatic resections were attempted in three patients. Preoperative diagnoses were insulinoma in two patients and cystadenoma in one patient. The lesions were located in the pancreas body in two patients and the pancreas tail in one patient. Their sizes ranged from 1 to 6 cm in diameter (mean, 3 cm). RESULTS: We performed distal pancreatectomy using an endoscopic linear stapler with conservation of the spleen in two patients and enucleation in one patient. Of the distal pancreatectomies, the splenic artery and vein were preserved in one patient, whereas in the other they were divided. There were no perioperative complications in any of the cases. The mean postoperative hospital stay was 10 days (range, 7-14 days). There were no episodes of hypoglycemia or recurrence during the mean follow-up period of 25 months (range, 11-36 months). CONCLUSIONS: Although laparoscopic pancreatic resection of selected patients is a feasible and safe procedure in the hands of experienced laparoscopic surgeons, patients must be carefully observed after surgery to avoid serious conditions by pancreatic fistula.