Robotic Parenchyma-Preserving Pancreatic Resection for Focal Congenital Hyperinsulinism in an Infant.
Manjunath Haridas, Arvind Sabharwal, Ajay N et al.
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Case in brief
An infant weighing 4.6 kg with focal congenital hyperinsulinism underwent robot-assisted, parenchyma-preserving pancreatic resection using indocyanine green, intraoperative ultrasound, and suture-based retraction. Frozen sections confirmed excision of the focal lesion; final histopathology showed focal adenomatous hyperplasia. Plasma glucose transiently rose after resection, peaking at 23.1 mmol/L, and intravenous dextrose was stopped. Recovery was uneventful, with discharge on postoperative day nine after the infant tolerated full oral feeds. At 8-month follow-up, the child remained euglycemic without medical therapy or hypoglycemic episodes.
What made this case unusual
The report describes robotic pancreatic resection in a very small infant weighing 4.6 kg, where restricted operative space and delicate tissues pose technical challenges. Suture-based retraction and adjunct imaging supported a parenchyma-preserving approach.
Diagnostic / clinical pearl
In focal congenital hyperinsulinism, intraoperative frozen sections can confirm excision of the focal disease; this case also illustrates the use of intraoperative ultrasound and indocyanine green during robotic resection.