Robotic enucleation of pancreatic head insulinoma in two cases with challenging tumor locations

Presenter: John D Karalis MD | University of Texas Southwestern Medical Center Background: Insulinomas are rare neuroendocrine tumors for which surgical resection is the cornerstone treatment. Enucleation insulinomas located in head pancreas can be challenging but preferable to avoid morbidity associated with pancreaticoduodenectomy. Our video-presentation aims describe our technique robotic enucleation pancreatic insulinomas. Methods: video describes clinical presentation, diagnostic imaging and technical aspects approach two patients that underwent enucleation. Results: The first patient a 76-year-old female who presented 2-month history syncope. Biochemical work-up revealed blood glucose level 35 mg/dl, C-peptide 3.3 ng/mL, proinsulin 90 pmol/L. CT 1.5x1.3 cm medial mass, posterior superior mesenteric artery vein, anterior left renal close proximity duct. Pre-operatively, aid intra-operative visualization duct, duct stent was placed endoscopically. Robotic mass performed. Intraoperative ultrasound used identify preserve integrity Pathology 1.2 well-differentiated tumor. patient’s post-operative course uneventful; her levels normalized, she received diet on day 1, drain removed 3, discharged home 5. second 61-year-old male previous cell carcinoma treated robotic-assisted right nephrectomy mild symptoms attributed hypoglycemia, ranging from 50-70 mg/dl. an elevated 8.9 ng/ml 98 pmol/L, respectively. abutting main requiring careful dissection. 1.5 he his 4, Conclusion: safe feasible option treatment locations. Preoperative stenting useful identification preservation during operation, use intraoperative essential tumor localization. Surgical proficiency profound understanding anatomy successful tumors.