Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Ann Surg Oncol. 2024 Mar;31(3):1834. doi: 10.1245/s10434-023-14627-5. Epub 2023 Nov 28.
Insulinomas are rare pancreatic neuroendocrine tumors for which the main curative treatment is surgical resection. Enucleation is preferred over pancreatoduodenectomy to minimize morbidity and function loss. Robotic-assisted surgery offers improved versatility and less blood loss than laparoscopic surgery for pancreatic enucleation. Our video describes the technique for robotic enucleation of pancreatic head insulinomas in close proximity to the pancreatic duct.
The video describes the presentation, diagnostic imaging, and technical aspects of the surgical approach in two patients with pancreatic head insulinomas that underwent robotic enucleation.
Case one was a 76-year-old woman who experienced syncope for 2 months. Case two was a 61-year-old man, previously treated for renal cancer, who had documented hypoglycemic symptoms. Computed tomography (CT) scan and magnetic resonance imaging (MRI) identified a 1.5 cm and 1.2 cm pancreatic head mass, respectively. Both patients presented with low glucose levels, and elevated C-peptide and proinsulin. In both cases, endoscopic retrograde cholangiopancreatography (ERCP) and pancreatic duct stent placement were performed the same day of surgery for intraoperative identification and preservation of the duct. Robotic enucleation of the masses was performed, and an ultrasound was used to identify the masses and relation with main pancreatic duct. Pathology revealed a well-differentiated neuroendocrine tumor in both cases. The patient's postoperative course was uneventful, and they were discharged on day 5. Successful resolution of hypoglycemic events occurred in both patients.
Robotic enucleation is a safe and feasible option for treating pancreatic head tumors in challenging locations. Intraoperative ultrasound is an essential tool for the successful robotic enucleation of pancreatic head tumors.
胰岛素瘤是一种罕见的胰腺神经内分泌肿瘤，主要的治疗方法是手术切除。为了最大限度地减少发病率和功能丧失，应选择肿瘤剜除术而非胰十二指肠切除术。与腹腔镜手术相比，机器人辅助手术可为胰腺肿瘤剜除术提供更好的灵活性和更少的出血。我们的视频描述了靠近胰管的胰腺头部胰岛素瘤的机器人剜除技术。
视频描述了两名胰腺头部胰岛素瘤患者的临床表现、诊断影像学和手术方法的技术方面，他们均接受了机器人剜除术。
病例一为一名 76 岁女性，因晕厥发作 2 个月就诊。病例二为一名 61 岁男性，曾因肾癌接受治疗，有明确的低血糖症状。计算机断层扫描（CT）和磁共振成像（MRI）分别识别出 1.5 厘米和 1.2 厘米的胰腺头部肿块。两名患者均表现为低血糖水平，C 肽和胰岛素原升高。在这两种情况下，同一天手术进行了内镜逆行胰胆管造影术（ERCP）和胰管支架置入术，以便术中识别和保留胰管。进行了机器人肿瘤剜除术，术中使用超声识别肿瘤及其与主胰管的关系。病理检查显示两种情况下均为分化良好的神经内分泌肿瘤。患者术后恢复顺利，于第 5 天出院。两名患者的低血糖事件均成功缓解。
机器人剜除术是治疗具有挑战性位置的胰腺头部肿瘤的安全可行的选择。术中超声是成功进行胰腺头部肿瘤机器人剜除术的重要工具。
