Robotic enucleation for pediatric insulinoma with MEN1 syndrome: a case report and literature review

Abstract

BackgroundA patient with a rare pediatric insulinoma and MEN1 syndrome was treated by robotic enucleation surgery.Case presentationWe present a case of a 9-year-old girl presenting with repeated loss of consciousness, concomitant with a pale face, palpitations, and convulsions, which had persisted for 2 years and had been aggravated during the previous 2 months. She was previously misdiagnosed with epilepsy in another hospital. We further examined her while she was hospitalized. By combining her medical history and imaging examination and lab test results, a diagnosis of insulinoma was confirmed. Sanger-directed sequencing on a peripheral blood sample revealed an MEN1 gene mutation, indicating pediatric insulinoma with MEN1 syndrome. The patient underwent minimally invasive insulinoma enucleation surgery under the Da Vinci robot-assisted system with intraoperative ultrasound (IOUS) connected. The surgery was successfully completed within 65 min, and the girl recovered well postoperatively and no longer experienced symptoms of hypoglycemia.ConclusionThis is the first report of a case of pediatric insulinoma treated using robotic enucleation. This experience demonstrates the feasibility and safety of combining robotic surgery with the enucleation procedure as an excellent strategy for pediatric insulinoma.

A Rare Case of Insulinoma in a Thin, Lean Adult Male: A Case Report

“…Other choices incorporate laparoscopy, which has comparable results [ 4 ]. Both short- and long-term comparable results have been reported in a small number of cases for mechanical enucleation of insulinoma as compared to the laparoscopic approach [ 5 , 6 ].…”

Robotic-Assisted Minimally Invasive Surgery in Children

“…This technique provides the dual benefits of minimal invasiveness and good preservation of the pancreatic parenchyma. The experience has demonstrated the feasibility and safety of the RAS enucleation, with an excellent curative effect for pediatric insulinoma [120,121].…”

Minimally invasive surgery of the pancreas: a narrative review of current practice

“…Enucleation of solitary, benign tumors may reduce the morbidity associated with more extensive pancreatic resections. This technique may be applied with cases of focal hyperinsulinemia, pNETs and small benign lesions that are remote from the main pancreatic duct (17,27). These tumors must be superficial, size less than 2 cm and at least 2 mm from the main pancreatic duct (28).…”