Laparoscopic pancreatic surgery in patients with neuroendocrine tumours: indications and limits

Laparoscopic pancreatic procedures are still at an evaluation stage with re gard to their indications and techniques. Between January 1998 and December 2000, 13 patients with endocrine pancreatic tumours - 11 insulinomas and 2 non-functioning rumours - underwent laparoscopic surgery, laparoscopic ult rasonography being used in all the patients. Enucleation was performed in f ive patients. The operative time was 2-3 hours. Distal pancreatectomy was p erformed in six patients with insulinomas, and spleen preservation with int act splenic vessels was feasible in five. Splenectomy was necessary in one patient for technical reasons. Laparoscopic distal pancreatectomy with sple nic vessel preservation was performed in two patients with a large (6 and 8 cm) non-functioning tumour. The mean operative time for all the patients u ndergoing distal pancreatectomy was 4 hours, ranging from 3 to 5 hours. A p ancreatic fistula occurred in three patients after tumour enucleation and i n two patients after distal pancreatectomy; the mean hospital stay for all patients was 5 days. Enucleation guided by laparoscopic ultrasonography thu s allows safe tumour dissection and excision, laparoscopic distal pancreate ctomy also being feasible and safe. Splenic salvage with splenic vessel pre servation is technically possible. The laparoscopic approach allows a short er hospital stay and an earlier return to normal activities.