Laparoscopic Localization and Resection of Insulinomas

Hypothesis: Laparoscopic localization and resection of insulinomas are feasible and safe and may decrease morbidity and the length of hospitalization. Design: Case series identified through retrospective medical record review. Setting: Mayo Clinic, Scottsdale, Ariz, and Rochester, Minn, a single-institution tertiary care medical center. Patients: Nine patients (6 men and 3 women; mean age, 54 years) who underwent attempted laparoscopic insulinoma resection between September, 1997, and April, 2002. Interventions: Laparoscopic localization and resection of insulinoma tumors of the pancreas. Main Outcome Measures: Intraoperative complications, conversion to open laparotomy, and length of hospitalization. Results: Preoperative localization was successful in 5 patients (56%). Four conversions to open exploration were required because of an inability to identify the tumor (n = 3) or to perform a safe laparoscopic resection owing to proximity to the portal vein (n = 1). Laparoscopic intraoperative ultrasonography facilitated identification of lesions (mean tumor size, 2.1 cm) in 4 (80%) of 5 patients; 3 patients underwent successful laparoscopic resection. Average hospital stay was shorter after laparoscopic resection (4.5 vs 7.0 days in uncomplicated cases). At follow-up (mean, 29 months; range, 3-57 months), 1 patient who underwent laparoscopic enucleation had recurrent hypoglycemia. Conclusions: Laparoscopic localization and resection of insulinomas are feasible and safe. Laparoscopic ultrasound aids successful insulinoma localization and laparoscopic resection. Preoperative localization is not required, but previous knowledge of tumor location helps focus intraoperative ultrasound and limit pancreatic mobilization. Excluding patients with pancreatic leaks (observed in both groups), hospital stay and time to recovery may be shortened by using laparoscopic insulinoma resection.