Laparoscopic Enucleation of Insulinomas

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Abstract
Insulinoma is the most common pancreatic endocrine neoplasm, occurring in 1 per 1 million persons each year. They are typically well encapsulated and less than 2 cm in diameter. Ninety percent are solitary and benign, and the remaining 10% are malignant. Multifocal insulinomas are more common in patients with multiple endocrine neoplasia type 1. The diagnosis of insulinoma is established by measuring insulin and C-peptide levels during a 72-hour fast and by calculating the ratio of insulin-to-glucose in the presence of hypoglycemia. The presence of sulfonylureas must be excluded by blood testing. Treatment is by excision. In the prelaparoscopic era, enucleation was performed via a laparotomy. Since then, surgeons have described their experience with laparoscopic enucleation and distal pancreatectomy.1-5 When enucleation is technically feasible, pancreatectomy provides no oncologic advantage, and it often requires an otherwise unnecessary splenectomy. However, few cases of successful laparoscopic enucleation have been reported,1-5 and its efficacy has not been established, to our knowledge.