Abstract: Objective:To investigate the value of the multi slice spiral computed tomography (MSCT) perfusion scan and intraoperative ultrasonography (IOUS) for localizing insulinoma in the da Vinci robotic surgical system.
Methods:The clinical data of 20 patients with insulinoma who were admitted to the Peking Union Hospital from July 2013 to July 2014 were retrospectively analyzed. The condition of the patients was evaluated by MSCT perfusion scan before operation, and the tumor was located by ultrasonograhy during the operation. The operation methods were selected according to the location of the tumors. The diagnostic accuracy of the MSCT perfusion scan and IOUS for locating insulinoma was analyzed, and the operation time, volume of intraoperative blood loss, peri operative complications, pre and postoperative levels of blood glucose were recorded. Patients were followed up via out patient examination and phone call till July 31, 2014. The count data were presented by ±s and were analyzed using the t test.
Results:Twenty one insulinomas were detected in the 20 patients. The accurate rate of the MSCT perfusion scan was 90.0% (18/20) in locating the tumor, and the accurate rate of the MSCT perfusion scan and intraoperative ultrasonography was 100.0%(20/20). The blood flow, blood volume, permeability were (97±37)mL/(100 mL·min), (20±14)mL/100 mL and (38±22)mL/(100 mL·min) in the normal pancreatic tissues, and (170±50)mL/(100 mL·min), (26±14)mL/100 mL and (51±42)mL/(100 mL·min) in the tumor tissues. The blood flow of the tumor tissues was significantly higher than that of the normal pancreatic tissues (t=5.58, P<0.05), while no significant difference was detected in the blood volume and permeability between the tumor tissues and the normal pancreatic tissues (t=1.31, 1.18, P>0.05). Eleven insulinomas were located at the head of the pancreas, 6 at the body of the pancreas and 4 at the tail of the pancreas. Of the 20 patients, 19 received enucleation of the insulinoma in the da Vinci robotic surgical system (1 of the them was converted to open surgery), and 1 patient received spleen preserving distal pancreatectomy in the da Vinci robotic surgical system. The operation time and median volume of blood loss were (146±54) minutes and 50 mL (range, 20 -1 000 mL), respectively. No complications such as bleeding, infection or death occurred after the operation. Eleven patients were complicated with grade A pancreatic fistula and 9 with grade B pancreatic fistula. The levels of blood glucose before operation and at 60 minutes after the operation were (3.8±1.0)mmol/L and (6.4±1.8)mmol/L, with significant difference (t=6.69, P<0.05). The symptoms were dismissed at the deadline of the follow up, with the remission rate of 100.0%(20/20).
Conclusion:Combination of MSCT perfusion scan and IOUS could improve the diagnostic rate of insulinoma, and significantly increase the efficacy of da Vinci robotic surgical system for treating insulinoma.