title: A prospective evaluation of laparoscopic exploration with intraoperative ultrasound as a technique for localizing sporadic insulinomas.
abstract: BACKGROUND
  Preoperative imaging studies localize insulinomas in less than 50% of patients. Arteriography with calcium stimulation and venous sampling (ASVS) regionalizes greater than 90% of insulinomas but requires specialized expertise and an invasive procedure. This prospective study evaluated laparoscopic exploration with IOUS compared with the other localization procedures in patients with a sporadic insulinoma.
  
  
  METHODS
  Between March 2001 and October 2004, 14 patients (7 women and 7 men; mean age, 53) with an insulinoma were enrolled in an IRB-approved protocol. Computed tomography, magnetic resonance imaging, ultrasound scan, and arteriography with calcium stimulation and venous sampling were performed preoperatively. A surgeon, blinded to the results of the localizing studies, performed a laparoscopic exploration with intraoperative ultrasound (IOUS). At the completion of the exploration, the success of laparoscopy for localization was scored, and the tumor was resected.
  
  
  RESULTS
  Twelve of 14 tumors were localized successfully before laparoscopy (noninvasive, 7 of 14; invasive, 11 of 14). Laparoscopic IOUS localized successfully 12 of 14 tumors. All lesions were resected, and all patients were cured (median follow-up, 36 months).
  
  
  CONCLUSIONS
  Laparoscopic IOUS identified 86% of tumors. The authors consider laparoscopic IOUS to be equivalent to ASVS in localizing insulinomas. Further study is therefore warranted to determine the role of laparoscopy with IOUS in the localization and treatment algorithm for patients with sporadic insulinoma.
authors.affiliation: Surgical Metabolism Section, Surgery Branch, NCI, National Institutes of Health, Bethesda, MD 20892-1502, USA.
authors.forename: Amelia C
authors.initials: AC
authors.lastname: Grover
authors.forename: Monica
authors.initials: M
authors.lastname: Skarulis
authors.forename: H Richard
authors.initials: HR
authors.lastname: Alexander
authors.forename: James F
authors.initials: JF
authors.lastname: Pingpank
authors.forename: Edward D
authors.initials: ED
authors.lastname: Javor
authors.forename: Richard
authors.initials: R
authors.lastname: Chang
authors.forename: Thomas
authors.initials: T
authors.lastname: Shawker
authors.forename: Phil
authors.initials: P
authors.lastname: Gorden
authors.forename: Craig
authors.initials: C
authors.lastname: Cochran
authors.forename: Steven K
authors.initials: SK
authors.lastname: Libutti
mesh_terms: D000328:Adult; D000368:Aged; D000768:Anesthesia, General; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007340:Insulinoma / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000601:surgery; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000601:surgery; D011446:Prospective Studies; D016037:Single-Blind Method; D025321:Surgery, Computer-Assisted; D014463:Ultrasonography