Green indocyanine in minimally invasive spleen preserving distal pancreatectomy for insulinoma: report of two cases

: A correct localization of pancreatic neuroendocrine tumors is the goal for a minimally invasive pancreatic procedure. Recently, the application of green indocyanine fluorescence is used to identify an intraoperative target pancreatic hypervascular lesion, that represents the most challenging aspect of the surgical procedure. Intraoperative ultrasonography represents the most common tool for pancreatic insulinoma recognition; in recent years, especially in the field of minimally invasive surgery, both robotic and laparoscopic, the application of indocyanine green fluorescence established its role to improve the success of identification also for small or undetected intrapancreatic lesions. Few authors reported their results about the application of green indocyanine fluorescence to intraoperative detection of pancreatic insulinoma and in our study, we describe a preliminary experience with the presentation of first two cases: 1 laparoscopic and 1 robotic spleen preserving distal pancreatectomy for insulinoma with the intraoperative use of green indocyanine fluorescence. We noticed that the intravenous administration of 25 mg green indocyanine allowed us to visualize an intrapancreatic hyperfluorescent area corresponding to the insulinoma, already recognized also by intraoperative ultrasound. Our aim was to investigate the safety and feasibility of green indocyanine fluorescence technique for the proper localization of pancreatic functional lesions during minimally invasive pancreatic surgery, and a brief comparison with published series was conducted.