title: Laparoscopic versus open approach for solitary insulinoma.
abstract: BACKGROUND
  In recent years, advances in laparoscopic techniques have allowed surgeons to treat pancreatic lesions laparoscopically. Insulinoma, the most prevalent pancreatic endocrine tumor, is mostly benign and curable with surgical resection. This study aimed to assess the results from laparoscopic resection (LG) of insulinomas and to compare them with the results from open surgery (OG).
  
  
  METHODS
  From September 1999 to December 2005, 56 laparoscopic pancreatic resections were performed for selected patients, including 12 laparoscopic resections of insulinomas. The results were compared with those of patients who underwent open resection of insulinomas selected from the authors' pancreatic database.
  
  
  RESULTS
  Three conversions to the open approach were required because of inability to identify the tumor. There were no deaths in either group, and the morbidity rates were 25% (3/12) for LG and 55% (5/9) for OG (nonsignificant difference). The pancreatic fistula rate after laparoscopic enucleation was statistically lower than after open enucleation (14% vs 100%; p = 0.015). The mean postoperative hospital stay was 13 +/- 5.9 days for LG and 17.6 +/- 7.5 days for OG (nonsignificant difference). After exclusion of the patients who underwent conversion to laparotomy, the mean postoperative hospital stay was 11.5 +/- 5.8 days for LG and 17.6 +/- 7.5 days for OG (p = 0.04).
  
  
  CONCLUSIONS
  This study demonstrates the feasibility and safety of laparoscopic resection of insulinomas. The laparoscopic approach was associated with a decrease in hospital stay and pancreatic fistula after enucleation. Preoperative localization tests and laparoscopic ultrasonography seem necessary to prevent conversion.
authors.affiliation: Department of Digestive Surgery, Chu Bordeaux, Avenue Magellan, Pessac, France, 33604. antonio.sa-cunha@chu-bordeaux.fr
authors.forename: Antonio
authors.initials: A
authors.lastname: Sa Cunha
authors.forename: Cedric
authors.initials: C
authors.lastname: Beau
authors.forename: Alexandre
authors.initials: A
authors.lastname: Rault
authors.forename: Bogdan
authors.initials: B
authors.lastname: Catargi
authors.forename: Denis
authors.initials: D
authors.lastname: Collet
authors.forename: Bernard
authors.initials: B
authors.lastname: Masson
mesh_terms: D000328:Adult; D000368:Aged; D019160:Endosonography; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007340:Insulinoma / Q000175:diagnosis / Q000601:surgery*; D010535:Laparoscopy / Q000009:adverse effects; D007902:Length of Stay; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010185:Pancreatic Fistula / Q000453:epidemiology / Q000209:etiology; D010190:Pancreatic Neoplasms / Q000175:diagnosis / Q000601:surgery*; D011877:Radionuclide Imaging; D014057:Tomography, X-Ray Computed