Section 6. Digestive organs: Minimally invasive endocrine surgery: laparoscopic resection of insulinomas

Pancreatic insulinomas are mostly benign and solitary tumors. Successful management of patients with insulinoma relies on accurate localization of the tumors and the use of appropriate surgical techniques. However, preoperative radiological imaging studies often fail to localize the insulinomas because of the small tumor sizes. Conventional intraoperative ultrasonography combined with palpation has been widely used as the best localization tool. Since contact ultrasonography, a new technique for localizing pancreatic lesions, became available as a laparoscopic study, several surgeons have utilized laparoscopy for not only localization but also resection of insulinomas. Previous reports of laparoscopic ultrasonography for intraoperative identification of insulinomas showed a 100% success rate in cases with insulinoma localized by preoperative imaging studies, but a less satisfactory rate in cases with occult insulinoma. Laparoscopic resection of insulinomas located in the head of the pancreas is often difficult because of its anatomical relationship with important adjacent structures such as pancreatic duct and mesenteric vessels. In contrast, insulinomas located in the body or tail of the pancreas are laparoscopically resectable even when they are in close proximity to the major pancreatic duct. Laparoscopic procedure is a feasible technique with low morbidity for surgical management of insulinomas. Accurate preoperative localization is essential for safe performance of this minimally invasive procedure.