LAPAROSCOPIC DISTAL PANCREATECTOMY GUIDED BY VIRTUAL LAPAROSCOPY

—A Case Report—

Abstract

The patient was a 77-year-old woman who was examined at our hospital for the chief complaint of sudden presyncope. A detailed examination led to the suspicion of insulinoma. Dynamic CT revealed a 10-mm nodular shadow in the pancreatic body; the patient was diagnosed with insulinoma in the pancreatic body through selective intra-arterial calcium-stimulated hepatic venous sampling (ASVS). Virtual laparoscopic images were created based on this CT image, and the data was transferred to an iPad for intraoperative reference. We subsequently performed laparoscopic distal pancreatectomy using these images. We could safely proceede with the operation while confirming the position of the primary vessel, and we were able to identify an appropriate pancreatic resection line while verifying the position of the tumor. After the surgery, her symptoms became less severe, with no complications such as pancreatic fistula or hypoglycemic attack, and she was discharged. An operative guide using virtual laparoscopic images is considered to be useful for the safe performance of laparoscopic distal pancreatectomy.