Intraoperative Ultrasonography

The first report of intraoperative imaging of an insulinoma by ultrasonography was by Lane and Coupland in 1982.38 In 1985, Norton and colleagues reported the first intraoperative localization by ultrasonography of an insulinoma that had eluded preoperative identification.39 In the last 20 years, numerous studies have documented that intraoperative ultrasonography (IOUS) is a very sensitive method for the localization of pancreatic insulinomas (Fig. 79-11A). The reported sensitivity of IOUS is 75% to 91%, and it improves with experience.40,41 In addition, IOUS can provide valuable information about the relationship of the tumor to critical structures such as the pancreatic duct, portal vein, common bile duct, and superior mesenteric vessels. This technique is shown in Figure 79-12A. Note that full mobilization of the pancreas is required to perform the procedure properly.

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