Lateral Laparoscopic Approach to Pancreatic Tail Insulinomas

ABSTRACT Pancreatic endocrine tumors are relatively rare lesions and laparoscopic surgery is being increasingly used, especially for insulinomas because of their relatively small size and low incidence of malignancy. Laparoscopic approach to pancreatic tumors has been described in the supine position, transomentally via the lesser sac with anterior stomach retraction. We propose a simplified lateral laparoscopic approach to insulinomas localized preoperatively to the tail or distal body of pancreas. Four patients with pancreatic tail insulinomas underwent laparoscopic surgery between November 2006 and February 2008. Diagnosis was confirmed by fasting sugar, insulin and proinsulin assays. Lesions were localized by multiphasic CT scan/MRI scan and endoscopic ultrasound. All these cases had definitely identifiable enhancing lesions in the distal body/tail in relation to the splenic hilum that appeared accessible by a lateral approach. Except for the first case which was done through the traditional supine approach, the other cases were done by the lateral approach. The patients were positioned right lateral with a kidney bridge. Four subcostal ports were placed and the left colon and spleen with pancreatic tail were mobilised in the same fashion as for splenectomy or adrenalectomy. Tumors were easily identifiable corresponding to the imaging studies. Laparoscopic enucleation was successfully completed in all four patients with lesions in the tail of pancreas, one by the traditional approach and other three by the proposed lateral approach. One patient had associated splenectomy because of the proximity of the lesion to the splenic vessels. Two patients had minor pancreatic leak managed conservatively. The left lateral transperitoneal laparoscopic approach to insulinomas located in the tail of pancreas is feasible and safe. The procedure can be done with ease by surgeons who are familiar with adrenalectomy and splenectomy. How to cite this article Thomas JK, Abraham D, Joseph P, Paul MJ. Lateral Laparoscopic Approach to Pancreatic Tail Insulinomas. World J Endocr Surg 2012;4(1):3-7.