Laparoscopic Enucleation of the Insulinoma of the Pancreas

Takeshi Naitoh, MD FACS, T Morikawa, MD, M Kakyo, MD, M Kinouchi, MD, T Ando, MD, F Motoi, MD, S Egawa, MD, M Unno, MD. Department of Surgery, Tohoku University Hospital

Neuroendocrine tumor (NET) of the pancreas is considered as relatively low malignant tumor. It is often treated with laparoscopic surgery. Most popular procedure for the treatment of NET is pancreatic resection, such as distal pancreatectomy or Whipple procedure. However, from the view point of preservation of pancreas, over resection of the normal pancreas should be avoided. The laparoscopic enucleation of the pancreatic tumor is a minimal invasive surgery as a treatment of such a low malignant or benign tumor of the pancreas. However, tumor localization sometimes makes the procedure difficult. We recently have a case of insulinoma of the pancreas located at the upper margin of pancreatic neck and it was close to the splenic artery above the portal vein. We carefully considered the indication of laparoscopic surgery and performed laparoscopic enucleation of the tumor. The patient was positioned reverse Trendelenburg position. Five trocars were placed in the upper abdomen. We first dissect the gastrocolic ligament to open the omental bursa. We then dissected the peritoneum at the lower margin of the pancreatic neck and tunneling between pancreas and portal vein was performed to mobilize the neck of pancreas. Then the tumor was enucleated with electric cautery. The hemorrhage from the pancreatic parenchyma was controlled with suturing. The postoperative clinical course was uneventful and the patient discharged from hospital on 7POD without any complications. We conclude that this procedure is feasible, safe and really minimal invasive surgery as a treatment of pancreatic NET.