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Updated: Sep 1, 2025
Robotic Enucleation of an Intra-Pancreatic Insulinoma in the Pancreatic Head
Published on: January 3, 2020
Experience with intraoperative use of artificial pancreas during local resection of insulinoma
Yukio Asano1, Hiroyuki Kato2, Satoshi Arakawa2
1Department of Gastroenterological Surgery, Fujita Health University School of Medicine, Bantane Hospital Department of Surgery, 3-6-10 Otobashi, Nakagawa-ku, Aichi Prefecture, 454-8509, Japan. yukiasa@fujita-hu.ac.jp.
Insights
This study details using an artificial pancreas to manage blood glucose during surgery for pancreatic insulinoma. Adjusting the artificial pancreas algorithm successfully controlled glucose fluctuations, preventing hypoglycemia during the procedure.
Area of Science:
- Endocrinology
- Surgical Technology
- Medical Device Innovation
Background:
- Insulinoma, a rare pancreatic tumor, causes hypoglycemia due to excessive insulin production.
- Managing blood glucose during surgical resection of insulinoma is critical, especially with co-existing conditions.
- Artificial pancreas technology offers potential for precise glycemic control in complex surgical scenarios.
Observation:
- A 50-year-old woman presented with severe hypoglycemia due to an insulinoma.
- Initial attempts to use an artificial pancreas were complicated by glucose instability.
- The artificial pancreas algorithm required modification to effectively manage intraoperative glycemic fluctuations.
Findings:
- Successful tumor enucleation was performed with the modified artificial pancreas system.
- The artificial pancreas, with algorithmic adjustments, maintained intraoperative blood glucose levels within a safe range (94.8 ± 21.1 mg/dL).
- This approach effectively prevented hypoglycemia (blood glucose ≤ 70 mg/dL) during the surgical procedure.
Implications:
- This case highlights the feasibility and benefits of using an artificial pancreas for glycemic management during insulinoma surgery.
- Algorithmic customization of artificial pancreas devices is crucial for overcoming challenges in patients with dynamic glucose metabolism.
- This demonstrates a promising application of advanced technology in improving surgical outcomes for rare endocrine tumors.
Abstract:
A 50-year-old woman was hospitalized for fainting caused by hypoglycemia. Her blood glucose level was low (40 mg/dL), immunoreactive insulin was 16.9 μU/mL, and C-peptide level was high (4.8 ng/mL). Computed tomography and magnetic resonance imaging revealed a 7-mm tumor in the uncinate process of the pancreas. A selective arterial calcium injection test indicated an increase in the superior mesenteric artery. Insulinoma of the uncinate process of the pancreas was diagnosed, and tumor enucleation was planned using an artificial pancreas for intraoperative and postoperative blood glucose control. Hypoglycemia (blood glucose, 38 mg/dL) was observed from the onset of surgery. An artificial pancreas cannot be used if the blood glucose level is ≤ 70 mg/dL; thus, continuous glucose infusion was administered. The sudden rise in blood glucose prompted insulin infusion from the device, causing hypoglycemia. Controlling blood glucose levels is challenging when introducing the artificial pancreas. However, altering the device's blood glucose control algorithm controlled the fluctuating blood glucose level, and, intraoperative average blood glucose was raised to 94.8 ± 21.1 mg/dL, thereby avoiding hypoglycemia, that is, a blood glucose level of ≤ 70 mg/dL. We report a case in which an artificial pancreas was used for glycemic control during surgery for an insulinoma.
