Laparoscopic enucleation of insulinomas

Abstract

Hypothesis: Laparoscopic enucleation of insulinomas is safe and effective and is associated with a short hospital stay.

Design: Case series identified through retrospective review of medical records.

Setting: University of California, San Francisco Medical Center, a tertiary care referral hospital.

Patients: Nine patients with insulinomas that were thought to be suitable for laparoscopic enucleation.

Intervention: Laparoscopic enucleation of solitary insulinomas of the pancreas.

Main outcome measures: Successful enucleation, conversion to open operation, postoperative complications, and duration of hospitalization.

Results: Seven of 9 patients had curative laparoscopic enucleations of insulinomas. In the 2 other patients, the laparoscopic approach was converted to an open operation to perform a distal pancreatectomy. All patients were cured. Computed tomography (CT) localized the tumor in 5 of 9 patients; laparoscopic enucleation was successful in all 5. Endoscopic ultrasonography correctly identified the lesions in 2 of 3 patients with nondiagnostic CT scans. Both lesions were successfully enucleated laparoscopically. Postoperative pancreatic fistulas occurred in 7 of 9 patients, but they caused little morbidity. No patient required another operation. Five of 7 patients treated laparoscopically were discharged to home on the first postoperative day.

Conclusions: Laparoscopic enucleation was safe and effective. If the lesion was seen on CT, it could be removed laparoscopically. Endoscopic ultrasonography was useful for identifying lesions in patients whose CT scans were nondiagnostic. Pancreatic fistulas were common, but they resolved spontaneously and produced little morbidity. Laparoscopic enucleation resulted in a short hospitalization and rapid recovery for most patients.