Laparoscopic localization and resection of insulinomas.
OBJECTIVE
Laparoscopic localization and resection of insulinomas are feasible and safe and may decrease morbidity and the length of hospitalization.


METHODS
Case series identified through retrospective medical record review.


METHODS
Mayo Clinic, Scottsdale, Ariz, and Rochester, Minn, a single-institution tertiary care medical center.


METHODS
Nine patients (6 men and 3 women; mean age, 54 years) who underwent attempted laparoscopic insulinoma resection between September, 1997, and April, 2002.


METHODS
Laparoscopic localization and resection of insulinoma tumors of the pancreas.


METHODS
Intraoperative complications, conversion to open laparotomy, and length of hospitalization.


RESULTS
Preoperative localization was successful in 5 patients (56%). Four conversions to open exploration were required because of an inability to identify the tumor (n = 3) or to perform a safe laparoscopic resection owing to proximity to the portal vein (n = 1). Laparoscopic intraoperative ultrasonography facilitated identification of lesions (mean tumor size, 2.1 cm) in 4 (80%) of 5 patients; 3 patients underwent successful laparoscopic resection. Average hospital stay was shorter after laparoscopic resection (4.5 vs 7.0 days in uncomplicated cases). At follow-up (mean, 29 months; range, 3-57 months), 1 patient who underwent laparoscopic enucleation had recurrent hypoglycemia.


CONCLUSIONS
Laparoscopic localization and resection of insulinomas are feasible and safe. Laparoscopic ultrasound aids successful insulinoma localization and laparoscopic resection. Preoperative localization is not required, but previous knowledge of tumor location helps focus intraoperative ultrasound and limit pancreatic mobilization. Excluding patients with pancreatic leaks (observed in both groups), hospital stay and time to recovery may be shortened by using laparoscopic insulinoma resection.
Jaroszewski
Dawn E
DE
Division of General Surgery, Mayo Clinic, Scottsdale, AZ 85259, USA.
Schlinkert
Richard T
RT
Thompson
Geoffrey B
GB
Schlinkert
Denise K
DK
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007340:Insulinoma / Q000601:surgery*; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome