Laparoscopic Enucleation of an Insulinoma of the Pancreatic Uncinate Process

Abstract

The patient was a 50-year-old female. She was brought to the emergency department with loss of consciousness, and was detected as having marked hypoglycemia. Abdominal CT and MRI revealed a hyper vascular tumor, about 1 cm in diameter, in the pancreatic uncinate process. In the selective arterial secretagogue injection test, the serum insulin level was elevated only by stimulation via the anterosuperior pancreatoduodenal artery, which indicated tumor feeding by this artery. Under the diagnosis of solitary insulinoma located far (at least about 5 mm) from the main pancreatic duct, laparoscopic enucleation was performed. The enucleation was completed using mainly laparoscopic bipolar forceps. The patient's postoperative course was uneventful and she was discharged on postoperative day 15. Enucleation of an insulinoma, which is usually clearly harder than the pancreatic parenchyma, can be performed by laparoscopic approach as well as by the open approach while feeling the tumor margin by tactile sensing.