Recent advances in minimally invasive pancreatic surgery

For curative resection of pancreatic endocrine tumours, minimally invasive methods of pancreatic surgery, such as laparoscopy, should be indicated only for benign tumours. Among these uncommon tumours, pancreatic insulinomas are mostly benign and solitary. Successful management of patients with insulinomas relies on accurate localization of the tumour and the use of appropriate surgical techniques. Because of the small size of these tumours, conventional intraoperative ultrasonography combined with palpation has been widely regarded as the best localization procedure. Because contact ultrasonography, a new technique for localization of pancreatic lesions, can be used laparoscopically, several surgeons have used laparoscopy not only for localization, but also for resection of insulinomas. In the era of minimally invasive surgery for benign pancreatic lesions, we attempted laparoscopic-focused exploration of the pancreas for resecting insulinomas based on preoperative localization. We describe the use of this technique for the detection and resection of insulinomas and the results obtained, with a review of previous reports.