Detailed Abstract
[Video Exhibition - Biliary & Pancreas (Pancreas Disease/Surgery)]
[Biliary & Pancreas Video Exhibition 6] LAPAROSCOPIC SPLEEN-PRESERVING DISTAL PANCREATECTOMY FOR MULTIFOCAL INSULINOMA OF THE BODY OF PANCREAS
B SELVAKUMAR 1, E SAIKRISHNA 1, Vaibhav Kumar VARSHNEY 1, Lokesh AGARWAL 1, Subhash Chandra SONI 1, Peeyush VARSHNEY 1
1 Surgical Gastroenterology, All India Institute of Medical Sciences, Jodhpur (Rajasthan), India
Background : Insulinoma is usually a benign pancreatic neuroendocrine tumor(P-NET), 10% of which can be multifocal.
Methods : A 38-year-old man presented with recurrent seizures, blackouts, dizziness and excessive diaphoresis during fasting for the past 3 years. His MRI Brain was normal. His routine blood investigations were unremarkable except for random blood sugar <40 mg/dl. Insulin and C-peptide levels were 5.74uIU/ml(normal <3) and 1.25ng/mL(normal <0.6), respectively. A contrast-enhanced computed tomography(CT) abdomen followed by Gallium-68 Exendin positron emission tomography(PET)/CT showed two arterially-enhancing and GLP1-expressing lesions in the body and tail of the pancreas, likely insulinomas. He was planned for laparoscopic spleen-preserving distal pancreatectomy(lap SPDP) with intra-operative continuous glucose monitoring.
Results : In a reverse Trendelenberg position with leg-split, two 12 mm and two 5 mm ports were placed. The stomach was retracted anteriorly using two slings. The pancreatic neck was looped and transected with an endostapler. The distal body of the pancreas was dissected from the splenic vessels, sequentially clipping the supplying branches. Blood sugars increased spontaneously above 100 mg/dl after specimen removal. The operative duration was 300mins with 200ml blood loss. Post-operatively, he had a smooth recovery and was discharged on day 3. Histopathology showed seven grade 1 NETs, two in the proximal body and five in the tail, with the largest being 15x10 mm. At 12-months follow-up, he is doing well with complete resolution of all symptoms.
Conclusions : Lap spleen-preserving distal pancreatectomy is a safe method to treat benign pancreatic neuroendocrine tumors with minimal morbidity and avoids the risks of post-splenectomy infections.
Methods : A 38-year-old man presented with recurrent seizures, blackouts, dizziness and excessive diaphoresis during fasting for the past 3 years. His MRI Brain was normal. His routine blood investigations were unremarkable except for random blood sugar <40 mg/dl. Insulin and C-peptide levels were 5.74uIU/ml(normal <3) and 1.25ng/mL(normal <0.6), respectively. A contrast-enhanced computed tomography(CT) abdomen followed by Gallium-68 Exendin positron emission tomography(PET)/CT showed two arterially-enhancing and GLP1-expressing lesions in the body and tail of the pancreas, likely insulinomas. He was planned for laparoscopic spleen-preserving distal pancreatectomy(lap SPDP) with intra-operative continuous glucose monitoring.
Results : In a reverse Trendelenberg position with leg-split, two 12 mm and two 5 mm ports were placed. The stomach was retracted anteriorly using two slings. The pancreatic neck was looped and transected with an endostapler. The distal body of the pancreas was dissected from the splenic vessels, sequentially clipping the supplying branches. Blood sugars increased spontaneously above 100 mg/dl after specimen removal. The operative duration was 300mins with 200ml blood loss. Post-operatively, he had a smooth recovery and was discharged on day 3. Histopathology showed seven grade 1 NETs, two in the proximal body and five in the tail, with the largest being 15x10 mm. At 12-months follow-up, he is doing well with complete resolution of all symptoms.
Conclusions : Lap spleen-preserving distal pancreatectomy is a safe method to treat benign pancreatic neuroendocrine tumors with minimal morbidity and avoids the risks of post-splenectomy infections.
SESSION
Video Exhibition
Exhibition Hall 03/27 ~ 03/29 ALL DAY