Minimally invasive management of insulinomas. A case report

Recently, preoperative endoscopic ultrasonography (EUS) was shown to be less time consuming, posing less risk of adverse events than other more invasive diagnostic procedures used for locating insulinomas. Furthermore, laparoscopy can be part of a less aggressive approach in the management of such tumors, avoiding open surgery, which is used all out of proportion for benign small-size lesions, as insulinomas frequently are.

The reported case of pancreatic insulinoma involved a 45-year-old woman suffering from a neuroglycopenic syndrome. Tumor location was possible with endoscopic ultrasonography, which detected a hypoechoic 10 x 10-mm mass in the pancreatic tail. Tumor enucleation was accomplished laparoscopically.

Insulinomas may be managed with videolaparoscopy, but this approach, which is not applicable for multiple or malignant tumors, must be contraindicated also in single insulinomas located on the posterior wall or deeply in the head of the pancreas. The disadvantages of the laparoscopic approach, as compared with conventional surgery, are the absence of palpation and difficulty exploring the whole pancreas, which is partly overcome, but not completely eliminated, by EUS. The advantages are the absence of a parietal incision and good postoperative comfort. The reported low-invasive EUS laparoscopy sequence may be successful in selected cases of pancreatic insulinomas. However, it seems this treatment could be proposed for many patients affected by this benign disease.