Laparoscopic ultrasonography for resection of insulinomas

Background. There have been few reports on the use of laparoscopic ultrasonography as an aid for the resection of insulinomas. In this study, we review our experience with laparoscopic ultrasonography for the intraoperative localization and resection of insulinomas. Methods. We attempted laparoscopic resection of insulinomas in 7 patients (median age, 50 years) during a 4-year period. Preoperative imaging showed that 1 of the insulinomas was located in the head of the pancreas, 2 were located in the body, and 4 were located in the tail. Results. We identified the insulinomas in all 7 patients with laparoscopic ultrasonography. In 6 of the patients, the insulinomas were laparoscopically resectable, either by nucleation (4 patients) or by resection of the pancreatic tail (2 patients). Conversion to laparotomy was necessary for the insulinomas in the head of the pancreas because they were close to the portal vein and the major pancreatic duct. All patients showed improvement in their hypoglycemia after the operations. Minor leakage of pancreatic juice occurred in 4 patients, and this was resolved with conservative treatment. Conclusions. Laparoscopic ultrasonography is useful for the intraoperative localization of insulinomas. Laparoscopy is a safe and feasible technique for resecting insulinomas located in the body or tail of the pancreas.