title: A novel technique of needle-guided laparoscopic enucleation of insulinomas.
abstract: Insulinomas are rare, usually benign and solitary neuroendocrine tumors that cause oversecretion of insulin. Surgical excision remains the only treatment modality with the potential for cure. Compared to open extensive pancreatic resections, laparoscopic enucleation of these tumors offers effective treatment, and significantly reduced risks of complications. However, accurate tumor localization is extremely important, especially in cases of lesions deep seated into the head of the pancreas. We present here a novel technique of intraoperative localization of lesions that are not visible on the surface of pancreas. Using laparoscopic intraoperative ultrasound, tumors were located in the parenchyma of the pancreatic head and then an 18-G needle was inserted into the pancreatic lesion intraoperatively under laparoscopic sonographic guidance. The pancreatic parenchyma was then divided until the dome of tumor was visible, minimizing tissue trauma, and enucleation was performed. This technique is a useful tool that substantially improves the chances of successful laparoscopic enucleation of deep-seated small pancreatic insulinomas.
authors.affiliation: Departments of Surgery Radiology, St Mark's Hospital and Academic Institute, North West London Hospitals' NHS Trust Department of Surgery, Royal Surrey NHS Trust Hospital, Middlesex, UK.
authors.forename: Aggelos
authors.initials: A
authors.lastname: Laliotis
authors.forename: Jack
authors.initials: J
authors.lastname: Martin
authors.forename: Tim R
authors.initials: TR
authors.lastname: Worthington
authors.forename: Michele
authors.initials: M
authors.lastname: Marshall
authors.forename: Alberto M
authors.initials: AM
authors.lastname: Isla
mesh_terms: D005260:Female; D006801:Humans; D007340:Insulinoma / Q000000981:diagnostic imaging / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D009339:Needles; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D018084:Ultrasonography, Interventional / Q000379:methods*
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