Laparoscopic body-tail pancreatic resection for insulinoma

Abstract

Introduction. Insulinomas are the most common endocrine tumours of the pancreas. They are more frequent in females, and they are commonly less than 2 cm in diameter. If conservative treatment of typical clinical symptoms fails, detailed diagnostic procedures are necessary and surgical treatment is indicated. The aim of this report was to emphasize the need of pancreatic resection when insulinoma is poorly visualized during surgery and when it is not possible to perform intraoperative ultrasonography. Case Outline. A 27-year-old female patient suffered from hypoglycaemic episodes during physical efforts and fasting periods. After examination, diagnostic procedures and preoperative preparation, laparoscopic surgery was performed. The tumour was less than 10 mm in diameter, and it could not be visualized during laparoscopic exploration. The body and the tail of the pancreas were mobilized using ultrasound scissors and the resection was performed by two Endo GIA staplers. The surgical specimen was removed in an endo-bag. The postoperative course was without complications and the glycemic level was normalized. Macroscopic examination of the resected specimen showed a solitary, poorly demarcated, dark grey lesion, 0.8 cm in diameter, with a solid consistence in comparison with the surrounding gland tissue. Histological examination showed a poorly demarcated, subcapsular tissue in this area, consisting of uniform, irregular, cubic and short cylindrical cells, organized in clusters with pseudoglandular and ?zellballen? formations. Conclusion. In case when the insulinoma is so small in size that it cannot be visualized during operation, pancreas resection is a surgical procedure of choice. Laparoscopic surgery is preferred because of less postoperative complications and faster recovery.Uvod. Insulinom je najcesci endokrini tumor pankreasa s vecom ucestaloscu kod osoba zenskog pola. U 90% slucajeva precnik insulinoma je manji od 2 cm. Indikacija za operaciju se postavlja nakon neuspesnog konzervativnog lecenja, tipicnih klinickih simptoma i detaljnih dijagnostickih pregleda. Ovim prikazom zelela se istaci neophodnost resekcije pankreasa kada je otezano prepoznavanje insulinoma tokom operacije, u uslovima kada je intraoperaciona sonografija nedostupna. Prikaz bolesnika. Zena stara 27 godina je u anamnezi navela pojavu hipoglikemijskih kriza nakon perioda gladovanja i tokom fizickog napora. Obavljeno je detaljno ispitivanje i postavljena dijagnoza insulinoma. Hirurski zahvat je izvrsen laparoskopski. Eksploracijom se nije mogao potvrditi tumor ciji je precnik manji od 10 mm, te su ultrazvucnim makazama mobilisani telo i rep pankreasa, a resekcija je izvedena sa dve endo-GIA. Preparat je odstranjen endo-kesom. Postoperacioni tok je protekao bez komplikacija, a nivo glikemije se normalizovao. U reseciranom delu pankreasa makroskopski je uoceno solitarno, nejasno ograniceno, mrkosivkasto polje precnika 0,8 cm, nesto cvrsce konzistencije u odnosu na okolno zlezdano tkivo. Histoloskim pregledom se u opisanom polju nalazilo nejasno ograniceno subkapsularno tkivo, sagradjeno od uniformnih, nepravilnih kockastih i nisko cilindricnih celija rasporedjenih u trake, pseudoglandularne i tzv. zellballen formacije. Zakljucak. Ukoliko je insulinom male velicine, te se ne moze uociti tokom operacije, resekcija pankreasa je metoda izbora u hirurskom lecenju. Laparoskopski pristup je pozeljan zbog manjeg broja postoperacionih komplikacija i brzeg oporavka bolesnika.