CC BY 4.0 · Endoscopy 2025; 57(S 01): E236-E237
DOI: 10.1055/a-2550-3975
E-Videos

Intraoperative collaboration between surgeons and endoscopists who performed previous endoscopic ultrasound in laparoscopic ultrasound-guided pancreatic tumor enucleation

Kosuke Maehara
1   Department of Gastroenterology, Toranomon Hospital, Minato-ku, Japan (Ringgold ID: RIN13600)
,
Satoshi Okubo
2   Department of Gastroenterological Surgery, Toranomon Hospital, Minato-ku, Japan (Ringgold ID: RIN13600)
,
1   Department of Gastroenterology, Toranomon Hospital, Minato-ku, Japan (Ringgold ID: RIN13600)
,
Daisuke Hattori
1   Department of Gastroenterology, Toranomon Hospital, Minato-ku, Japan (Ringgold ID: RIN13600)
,
Yoshiki Sato
1   Department of Gastroenterology, Toranomon Hospital, Minato-ku, Japan (Ringgold ID: RIN13600)
,
Rikako Koyama
1   Department of Gastroenterology, Toranomon Hospital, Minato-ku, Japan (Ringgold ID: RIN13600)
3   Okinaka Memorial Institute for Medical Research, Tokyo, Japan
,
Tsunao Imamura
1   Department of Gastroenterology, Toranomon Hospital, Minato-ku, Japan (Ringgold ID: RIN13600)
3   Okinaka Memorial Institute for Medical Research, Tokyo, Japan
› Author Affiliations
 

Recent advancements in imaging technology and endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) have led to increased detection of small pancreatic tumors, enhancing the opportunities for surgical resection.

Laparoscopic pancreatic tumor enucleation is a suitable minimally invasive treatment, especially for tumors that usually have limited invasion into surrounding tissues, such as pancreatic neuroendocrine neoplasms and solid pseudopapillary neoplasms smaller than 10 mm [1] [2] [3]. However, the small size of these tumors makes them difficult to visualize with laparoscopic ultrasound, potentially complicating tumor localization and leading to over-extraction. At our institution, we have implemented a strategy to improve the accuracy of intraoperative tumor localization by having the endoscopist who performed the preoperative EUS also conduct the laparoscopic ultrasound during surgery. This approach may allow for more precise tumor identification and resection, avoiding excessive tissue removal while preserving the minimally invasive nature of the tumor enucleation.

We present the case of a 67-year-old man with a suspected pancreatic body cyst identified on an abdominal ultrasound, which was later confirmed on EUS as a 4-mm hypoechoic mass ([Fig. 1]). EUS-FNA ([Fig. 2]) revealed a diagnosis of pancreatic neuroendocrine neoplasm (G1). The patient opted for minimally invasive surgery, and laparoscopic enucleation was performed.

Zoom Image
Fig. 1 Initial imaging of the small pancreatic tumor (arrows). a, b Endoscopic ultrasound. c Contrast-enhanced computed tomography.
Zoom Image
Fig. 2 Endoscopic ultrasound-guided fine-needle aspiration of 4-mm pancreatic tumor. a B mode. b Color Doppler. c Fine-needle aspiration. d Confirming tumor recognition after puncture.

Initially, the surgeon’s laparoscopic ultrasound (ARIETTA 60; Hitachi, Ltd., Tokyo, Japan) using linear-array transducer failed to visualize the tumor, leading to multiple unsuccessful extractions. The endoscopist who had performed the preoperative EUS then took over the laparoscopic ultrasound, successfully delineating the tumor ([Fig. 3], [Video 1]). The surgeon confirmed the location, and tumor enucleation was completed successfully ([Fig. 4]).

Zoom Image
Fig. 3 Detecting the small pancreatic tumor using laparoscopic ultrasound by collaboration between surgeons and endoscopists. a Laparoscopic ultrasound probe with water immersion. b Laparoscopic ultrasound imaging (yellow arrows, small pancreatic tumor).
Zoom Image
Fig. 4 Enucleation of the small pancreatic tumor (arrow). a Laparoscopic image. b, c Comparison of laparoscopic ultrasound imaging before (b) and after (c) enucleation.

Quality:
Intraoperative collaboration between surgeons and endoscopists in the use of laparoscopic ultrasound for pancreatic tumor enucleation. ESU, endoscopic ultrasound; MPD, main pancreatic duct; SMV, superior mesenteric vein.Video 1

Postoperatively, the patient had no complications and showed no recurrence at the 9-month follow-up.

This case highlights the importance of intraoperative collaboration between surgeons and endoscopists to ensure accurate localization and successful outcomes in minimally invasive pancreatic surgery.

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Conflict of Interest

The authors declare that they have no conflict of interest.

  • References

  • 1 Bartolini I, Bencini L, Bernini M. et al. Robotic enucleations of pancreatic benign or low-grade malignant tumors: preliminary results and comparison with robotic demolitive resections. Surg Endosc 2019; 33: 2834-2842
  • 2 Shi Y, Jin J, Huo Z. et al. An 8-year single-center study: 170 cases of middle pancreatectomy, including 110 cases of robot-assisted middle pancreatectomy. Surgery 2020; 167: 436-441
  • 3 Ohtsuka T, Nagakawa Y, Toyama H. et al. A multicenter prospective registration study on laparoscopic pancreatectomy in Japan: report on the assessment of 1,429 patients. J Hepatobiliary Pancreat Sci 2020; 27: 47-55

Correspondence

Kosuke Maehara, MD
Department of Gastroenterology, Toranomon Hospital
2-2-2 Toranomon
Minato-ku, Tokyo 105-8470
Japan   

Publication History

Article published online:
20 March 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).

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  • References

  • 1 Bartolini I, Bencini L, Bernini M. et al. Robotic enucleations of pancreatic benign or low-grade malignant tumors: preliminary results and comparison with robotic demolitive resections. Surg Endosc 2019; 33: 2834-2842
  • 2 Shi Y, Jin J, Huo Z. et al. An 8-year single-center study: 170 cases of middle pancreatectomy, including 110 cases of robot-assisted middle pancreatectomy. Surgery 2020; 167: 436-441
  • 3 Ohtsuka T, Nagakawa Y, Toyama H. et al. A multicenter prospective registration study on laparoscopic pancreatectomy in Japan: report on the assessment of 1,429 patients. J Hepatobiliary Pancreat Sci 2020; 27: 47-55

Zoom Image
Fig. 1 Initial imaging of the small pancreatic tumor (arrows). a, b Endoscopic ultrasound. c Contrast-enhanced computed tomography.
Zoom Image
Fig. 2 Endoscopic ultrasound-guided fine-needle aspiration of 4-mm pancreatic tumor. a B mode. b Color Doppler. c Fine-needle aspiration. d Confirming tumor recognition after puncture.
Zoom Image
Fig. 3 Detecting the small pancreatic tumor using laparoscopic ultrasound by collaboration between surgeons and endoscopists. a Laparoscopic ultrasound probe with water immersion. b Laparoscopic ultrasound imaging (yellow arrows, small pancreatic tumor).
Zoom Image
Fig. 4 Enucleation of the small pancreatic tumor (arrow). a Laparoscopic image. b, c Comparison of laparoscopic ultrasound imaging before (b) and after (c) enucleation.