We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Invited Critique |

Laparoscopic Enucleation of Insulinomas—Invited Critique

Michael R. Marohn, DO
Arch Surg. 2007;142(12):1205. doi:10.1001/archsurg.142.12.1205.
Text Size: A A A
Published online


Sweet and colleagues provide a benchmark series of laparoscopic enucleation of pancreatic insulinomas. Insulinomas are the most common functional neuroendocrine pancreatic tumors; most are solitary and benign. Focusing on laparoscopic enucleation of these lesions is reasonable.

The authors report successful preoperative CT localization in only 5 of 9 patients, supplemented by EUS and successful in 2 of 3 patients with nondiagnostic CT scans. These data mirror other findings, with the caveat that EUS is heavily operator dependent and may reveal false-positive or false-negative results.1 The authors' description of laparoscopic intraoperative ultrasonography (used in 6 of 9 patients) as being of principal value to confirm CT findings and to demonstrate the relationship of the lesion to pancreatic duct and vascular anatomy may underrate the usefulness of intraoperative ultrasonography. Given that preoperative noninvasive imaging localizes only 50% to 55% of lesions, laparoscopic intraoperative ultrasonography may be a key operative localization tool to reduce conversion rates due to failure to identify the target lesion. Grover et al2 reported successful laparoscopic intraoperative ultrasonography in localizing 12 of 14 insulinomas (86%). A reasonable localization algorithm would be CT imaging, followed by laparoscopy with intraoperative ultrasonography if positive, and if negative, followed by EUS or calcium-stimulated venous sampling, or even directly to laparoscopy with intraoperative ultrasonography.

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview





Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

0 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...
Articles Related By Topic
Related Collections
PubMed Articles