Ultrasound-guided laparoscopic resection of pancreatic islet cell tumors

Pancreatic islet cell tumors represent a diverse group of neuroendocrine le sions. These tumors may be singular or multiple, benign or malignant, spora dic, or part of the constellation of multiple endocrine neoplasia type 1, T umors such as insulinomas and gastrinomas produce gastrointestinal peptides that lead to diagnosis. Nonfunctioning lesions may be found incidentally o r by screening patients Lit high risk for such tumors. Successful managemen t of patients with pancreatic islet cell tumors relies on accurate localiza tion and sound operative technique. With proper preoperative localization, advanced laparoscopic methods can be used to manage patients with these pan creatic neoplasms. Preoperative localization of pancreatic islet cell tumor s was difficult in the past. Standard imaging and localizing modalities, su ch as computed tomography scanning, magnetic resonance imaging, angiography , transabdominal sonography, and portal venous sampling, yield only 24% to 75% accuracy. Consequently, many biochemically suspected lesions cannot be imaged with current techniques. Decreased tactile sensation of laparoscopy adds complexity to intraoperative identification. Endoscopic sonography and laparoscopic sonography provide accurate: preoperative and intraoperative localization to enhance laparoscopic and open resection. The authors treate d two patients with islet cell neoplasms using endoscopic sonography to pre operatively visualize the tumors and laparoscopic sonography to guide lapar oscopic enucleation. Their approach and difficulties are discussed.