Laparoscopic strategies for resection of insulinomas.

Sporadic insulinomas are suitable for the laparoscopic approach because they are solitary, resectable, and not metastatic. Laparoscopy and laparoscopic ultrasonography (LapUS) can identify lesions that are undetectable by preoperative imaging techniques. However, it is still worthwhile to attempt preoperative imaging by endoscopic ultrasonography to provide useful information for patient positioning and port placement. Laparoscopic pancreatic resection and laparoscopic enucleation are feasible and safe techniques. Conversion to the open approach should be considered for tumors that cannot be identified accurately by LapUS. In patients with insulinomas in the setting of multiple endocrine neoplasia 1, the laparoscopic approach is slightly different. Laparoscopic subtotal distal pancreatectomy preserving the spleen combined with laparoscopic enucleation of any tumors identified in the pancreatic head should be the standard operation. The advantages of laparoscopic pancreatic procedures should be those of all laparoscopic procedures, which obviously reduce the parietal damage in the abdomen. This may be associated with reductions in postoperative pain and hospital stay and an earlier return to previous activity. A cosmetic advantage is also clear because of the absence of long abdominal incision, and this should be taken into account, especially in young women.