Srpski arhiv za celokupno lekarstvo 2012 Volume 140, Issue 3-4, Pages: 221-224
https://doi.org/10.2298/SARH1204221C
Full text ( 254 KB)
Laparoscopic body-tail pancreatic resection for insulinoma
Cvijanović Radovan (Klinika za abdominalnu, endokrinu i transplantacionu hirurgiju, Klinički centar Vojvodine, Novi Sad)
Ivanov Dejan (Klinika za abdominalnu, endokrinu i transplantacionu hirurgiju, Klinički centar Vojvodine, Novi Sad)
Mitrović Milena (Klinika za endokrinologiju, dijabetes i bolesti metabolizma, Klinički centar Vojvodine, Novi Sad)
Đolai Matilda (Centar za patologiju i histologiju, Klinički centar Vojvodine, Novi Sad)
Petrović Dejan (Klinika za abdominalnu, endokrinu i transplantacionu hirurgiju, Klinički centar Vojvodine, Novi Sad)
Tešić Olivera (Odeljenje za radioterapiju, Institut za onkologiju Vojvodine, Novi Sad)
Introduction. Insulinomas are the most common endocrine tumours of the
pancreas. They are more frequent in females, and they are commonly less than
2 cm in diameter. If conservative treatment of typical clinical symptoms
fails, detailed diagnostic procedures are necessary and surgical treatment is
indicated. The aim of this report was to emphasize the need of pancreatic
resection when insulinoma is poorly visualized during surgery and when it is
not possible to perform intraoperative ultrasonography. Case Outline. A
27-year-old female patient suffered from hypoglycaemic episodes during
physical efforts and fasting periods. After examination, diagnostic
procedures and preoperative preparation, laparoscopic surgery was performed.
The tumour was less than 10 mm in diameter, and it could not be visualized
during laparoscopic exploration. The body and the tail of the pancreas were
mobilized using ultrasound scissors and the resection was performed by two
Endo GIA staplers. The surgical specimen was removed in an endo-bag. The
postoperative course was without complications and the glycemic level was
normalized. Macroscopic examination of the resected specimen showed a
solitary, poorly demarcated, dark grey lesion, 0.8 cm in diameter, with a
solid consistence in comparison with the surrounding gland tissue.
Histological examination showed a poorly demarcated, subcapsular tissue in
this area, consisting of uniform, irregular, cubic and short cylindrical
cells, organized in clusters with pseudoglandular and “zellballen”
formations. Conclusion. In case when the insulinoma is so small in size that
it cannot be visualized during operation, pancreas resection is a surgical
procedure of choice. Laparoscopic surgery is preferred because of less
postoperative complications and faster recovery.
Keywords: insulinoma, laparoscopic surgery, hypoglycaemic coma