The Application Of LIOUS In The Localization And Laparoscopic Surgery Of Insulinomas

Backgroud and ObjectsLaparoscopic Surgery had been used in many areas in recent years.However the difficult of Localization of insulinomas had restricted the developments of Laparoscopic Surgery of Insulinomas.For the sake of evaluate the value of laparoscopic ultrasonography exploration in the Localization of insulinomas,we underwent a clinic study on the patients with localized insulinomas by Ultrasonography,CT,Sonovue,EUS,DSA and LIOUS.We also study the value of LIOUS in the operation.Materials and Methods:A total of 23 consecutive patients(13 women,10 men;mean age 38.6 years, range 21-60 years) underwent laparoscopic pancreatic surgery(LPS) from June 2007 to August 2007.All patients were make a definite diagnosis of insulinomas.Preoperative localization was done by ultrasonography,computed tomography,Digital Subtraction Angiography,endoscopic ultrasonography, sonovue.Laparoscopic Intraoperative Ultrasound were performed in all patients.Results:1.In this data,the sensitivity of LIOUS,DSA,EUS,Sonovue,CT scan,and ultrasonography for detection of pancreatic insulinoma about 91.3%, 67.7%,67.7%,64.7%,52.1%and 21.7%.the sensitivity of LIOUS and CT scan,and ultrasonography for detection of pancreatic insulinoma had the difference in statistics.2.In our data,laparoscopic enucleation were performed in 11 patients.2 patients had laparoscopic enucleation which were guided by LIOUS.3 patients had laparoscopic enucleation with preservation of splenic vessels.1 patient had conversion.2 patients had laparoscopic enucleation guided by LIOUS for the second insulinomas.1 patient had laparoscopic enucleation combined with laparoscopic distal pancreatectomy with preservation of splenic vessels.1 patient had laparoscopic enucleation hepatoduodenal ligament.2 patients only had a explortion of LIOUS. 3.laparoscopic surgery were perfoemed in 21 pationts.The postoperation blood sugar of all pationts rise to normal level.Only 5 patients had fistulas.Conclusions:LIOUS for detection of pancreatic insulinoma had a accurate sensitivity.It can identify most insulinoma combining with some preoperation imaging methods. Although LIOUS had no help for reducing the fistulas after laparoscopic surgery of insulinomas,LIOUS can make a great contribution to the operative management.