Laparoscopic Surgery for Pancreatic Insulinomas: A Single-Institution Experience of 29 Cases

Laparoscopic approach has been increasingly used in the treatment of pancreatic benign diseases. This report evaluates our experience with laparoscopic surgery for pancreatic insulinomas. Between July 2000 and December 2007, laparoscopic pancreatectomy was attempted in 29 consecutive patients with insulinomas. The localization of tumors, operating characteristics, and clinical outcomes were analyzed. Tumors were precisely localized in 28 of 29 (96.6%) patients by a combination of preoperative imaging techniques and intraoperative ultrasonography. Laparoscopic pancreatectomy was successfully performed in 26 patients, including enucleation (n = 14), hand-assisted enucleation (n = 2), and distal pancreatectomy with (n = 9) or without (n = 1) spleen preservation. Two conversions to open procedure were required because of unfavorable locations of the tumors. The pancreatic fistula occurred in four patients who underwent tumor enucleation. The median hospital stay was 5.5 days (range, 3-18 days) after laparoscopic procedure. Twenty-eight patients with pancreatic resection were free of symptoms and remained normoglycemic after a median follow-up period of 19 months (range, 10-36 months). Laparoscopic pancreatic resection is a feasible and safe procedure for patients with insulinomas. Further studies are required to evaluate the potential application of the hand-assisted approach for tumors located at anatomically unfavorable positions.