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Laparoscopic Insulinoma Enucleation From the Retro-Pancreatic Neck: A Stepwise Approach
Claudius Conrad*, Guillaume Passot, Suguru Yamashita, Matthew H. Katz, Jason B. Fleming, Michael P. Kim, Yun Shin Chun, Thomas Aloia, Jean-Nicolas Vauthey, Jeffrey E. Lee
Surgical Oncology, The UNiversity of Texas M.D. Anderson Cancer Center, Houston, TX

Background: A laparoscopic enucleation can be particularly challenging for retro-pancreatic insulinomas.
Patient: A 35-year-old woman was diagnosed with an insulinoma in the posterior pancreatic neck lateral to SMV-PV.
Technique: A retropancreatic tunnel was created anterior to the SMV-PV and a cerclage of the pancreatic neck was performed with umbilical tape to allow for retraction with minimal pancreatic manipulation. IOUS-guided clip placement facilitated direct identification and permitted safe image-guided enucleation.
Conclusion: This totally minimally-invasive approach can reduce the morbidity of pancreatic surgery and permit organ-sparing despite the challenging location.

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