Tsukayama Hiroyuki, Misawa Takeyuki, Watanabe Makoto, Takahashi Hideki, Koenuma Takashi, Kondo Rie, Toyoda Hiroe, Shibuya Makoto, Wada Keita, Sano Keiji
Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-Ku, Tokyo 173-8606, Japan.
Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-Ku, Tokyo 173-8606, Japan.
Int J Surg Case Rep. 2022 May;94:107115. doi: 10.1016/j.ijscr.2022.107115. Epub 2022 Apr 21.
Most insulinomas are benign and solitary, with a tumor diameter less than 2 cm; therefore, laparoscopic enucleation, which is a minimally invasive procedure that can preserve the pancreatic parenchyma, is considered an optimal procedure. The key to enucleation is to avoid injury to the main pancreatic duct (MPD). Herein, we present a case in which single-incision laparoscopic enucleation (SILE) was performed for insulinomas, with preoperative nasopancreatic stent (NPS) placement.
A male patient in his fifties underwent SILE for insulinomas. To prevent injury to the MPD, an NPS was preoperatively placed. All surgical procedures were performed through a single mini-laparotomy site in the umbilicus. NPS placement facilitated identification of the MPD under laparoscopic ultrasonography. Enucleation was successfully completed without any injury to the MPD, and the NPS was removed immediately after confirming that there was no injury to the MPD by the NPS via pancreatography. The postoperative course was uneventful.
This report serves to highlight the maximum safety and minimal invasiveness of SILE with the preoperative NPS placement. Preoperative NPS placement is useful for avoiding injury to the MPD during enucleation and has the merit of helping to recognize whether leakage occurs by intraoperative pancreatography via the NPS.
Preoperative NPS placement helps to ensure the safe enucleation of pancreatic insulinomas even in single-incision laparoscopic surgery, with minimal invasiveness and better cosmetic outcomes.
大多数胰岛素瘤为良性且孤立存在，肿瘤直径小于2厘米；因此，腹腔镜摘除术作为一种能够保留胰腺实质的微创手术，被视为最佳术式。摘除术的关键在于避免损伤主胰管（MPD）。在此，我们报告一例通过术前放置鼻胰支架（NPS）进行单切口腹腔镜胰岛素瘤摘除术（SILE）的病例。
一名五十多岁的男性患者接受了胰岛素瘤SILE手术。为防止损伤MPD，术前放置了NPS。所有手术操作均通过脐部的单个迷你剖腹手术切口进行。NPS的放置有助于在腹腔镜超声检查下识别MPD。成功完成摘除术，未对MPD造成任何损伤，在通过NPS进行胰管造影确认MPD未受损伤后，立即取出NPS。术后病程平稳。
本报告旨在强调术前放置NPS的SILE具有最大安全性和最小侵袭性。术前放置NPS有助于在摘除术中避免损伤MPD，并且具有通过术中经NPS进行胰管造影帮助识别是否发生渗漏的优点。
术前放置NPS有助于确保即使在单切口腹腔镜手术中胰腺胰岛素瘤也能安全摘除，具有最小侵袭性和更好的美容效果。
