Efficacy of laparoscopic ultrasonography in laparoscopic resection of insulinoma

Abstract

Insulinoma is the most common functioning islet cell tumor of the pancreas, with an annual incidence of 4 cases/1 million individuals. It is treated by surgical methods. Open surgery was once considered the standard approach for the treatment of insulinoma. However, the procedure is traumatic and requires a large incision, which does not satisfy the growing expectations of minimally invasive management of small-sized tumors. Insulinomas are usually benign solitary tumors and mostly occur sporadically, which makes them suitable candidates for laparoscopic management. The potential advantages of laparoscopic management of insulinoma over open surgery include shorter duration of hospitalization, quicker recovery, and better cosmetic effect. However, because of the small tumor size as well as the depth and uncertainty of the location of the tumor, laparoscopic localization of the lesion without tactile sensation is difficult. Laparoscopic ultrasonography can detect about 90% of insulinomas, and its sensitivity is comparable to that of manual palpation along with intraoperative ultrasonography during open surgery; thus, it ensures the feasibility of laparoscopic management of insulinoma and reinforces its advantage as a minimally invasive procedure. Laparoscopic ultrasonography is vital for the localization of insulinomas and characterization of the surrounding pancreatic structure and should, therefore, be considered an integral part of the laparoscopic management of insulinoma.

Value of multi-detector computed tomography during intra-arterial infusion of contrast medium for locating insulinomas

“…However, An et al. 2 , 5 , 11 reported a high sensitivity of 86.5% for CEUS in patients with insulinomas. According to Chinese standards, four patients (33.3%) in the present study were overweight (body mass index (BMI) ≥24.0 and <28.0 kg/m 2 ) and seven patients (58.3%) were obese (BMI ≥28.0 kg/m 2 ).…”

“…The sensitivity of ultrasonography is affected by various factors, such as the physician's expertise, patient's body weight, tumor size, and tumor location, leading to reported sensitivities of 0% to 86.5%. However, An et al 2,5,11 reported MDCT-IA, multi-detector CT during intra-arterial infusion of contrast medium.…”

Insulinoma presenting with post-prandial hypoglycaemia following fundoplication

“…Laparoscopic surgical resection is associated with shorter hospitalisation compared to traditional open surgical approaches; however, a disadvantage is the inability to perform manual palpation for intraoperative localisation. Laparoscopic ultrasonography can be useful and has been shown to have a sensitivity of around 90% ( 15 ). As this case demonstrates, however, the resection of small insulinomas can be challenging despite the use of pre-operative and intraoperative localisation techniques.…”

Laparoscopic ultrasonography: The wave of the future in renal cell carcinoma?

“…Laparoscopic ultrasonography (LUS) is a multimodal medical technique and allows visualization of tissues beyond the two-dimensional laparoscopic image, enhancing the amount and quality of information available to the surgeon. [ 1 ] In general surgery, LUS is mainly used in hepatobiliary and pancreatic diseases such as cholelithiasis in the common bile duct,[ 2 3 4 ] hepatic carcinoma, and insulinoma exploration;[ 5 6 ] in gynecology, LUS reduces the residual and recurrence rates of hysteromyoma[ 7 ] and helps explore the lymph nodes around cervical cancer. [ 8 ] In urological surgery, LUS is mostly used in renal diseases such as renal cysts, endogenous renal tumors, RCC with thrombolysis, real-time monitoring of RCC radiofrequency ablation (RFA), and cryoablation therapy.…”