Laparoscopic Resection

Originally described in 1996, laparoscopic distal pancreatectomy for the removal of an insulinoma is an approach that appeals to many who view a laparotomy with extensive retroperitoneal dissection as excessive to treat what is a usually benign tumor.46 Preoperative testing, usually by EUS with fine-needle aspiration, is required to ensure correct localization and to exclude malignancy. IOUS is frequently employed. One of the largest series to date reported an average hospital stay of only 5 days after such an approach was used for 10 endocrine tumors of the pancreas, 7 of which were insulinomas, either sporadic or multiple.47 Both enucleation and distal resections of the pancreas can be performed by this technique. Although these initial results are encouraging in this highly selected group of patients, conversion to an open procedure was required in 2 patients and postoperative fistulas were noted in 5 of 18 (28%) total patients in the series.

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