Insulinoma Surgery
Choosing an operation
Surgery is the preferred treatment for an insulinoma confined to the pancreas. ENETS recommends preserving healthy pancreatic tissue whenever feasible. Tumour size, position and distance from the main pancreatic duct guide the choice. [1]
Operations that preserve pancreatic tissue
Enucleation: removing the tumour itself. This may suit small insulinomas sufficiently far from the main pancreatic duct, which carries digestive juices. [1]
Central pancreatectomy: removing a middle section of the pancreas. This may suit tumours in the neck when enucleation is unsuitable. [1]
Removing a larger section
Distal pancreatectomy: removing the tail and part of the body of the pancreas. Sometimes the spleen also needs to be removed. [2]
Whipple’s operation: removing the pancreatic head, first part of the small bowel (duodenum), gallbladder, part of the bile duct and part of the stomach. A related operation, called pylorus preserving pancreaticoduodenectomy (PPPD), keeps the stomach. The surgeon reconnects the digestive tract. [2]
Keyhole or open surgery
Keyhole surgery should be considered when feasible. If scans have not located the insulinoma, ENETS recommends open surgery with ultrasound during the operation. [1]
Robotic surgery for an insulinoma
Robotic surgery is a form of keyhole surgery. The surgeon controls the instruments from a console in the operating theatre, using a magnified 3D view. [3,4]
It can be used for selected insulinomas, including enucleation. Your specialist team will consider the tumour’s position, the operation required, your health and the team’s experience. [1,4,5]
Neuroendocrine Cancer UK (NCUK) explains: “Robotic surgery uses small incisions, as in keyhole or laparoscopic surgery” (2023 guide, PDF page 5). [3]
ENETS 2023 recommends considering minimally invasive surgery when feasible. Question 6 does not specify that robotic surgery is better than standard keyhole surgery. [1]
A study comparing previous patient records found a shorter hospital stay after robotic enucleation than after standard laparoscopic enucleation, with no difference in pancreatic leak or overall complication rates. This does not establish that robotics is best for everyone. [5]
Robotic surgery still carries the risks of pancreatic surgery. The team may need to change to open surgery to complete the operation safely. Recovery depends on the operation and your individual circumstances. [2,4]
Risks and recovery
Pancreatic surgery can cause bleeding, infection, blood clots or leakage of digestive fluid. Some people need treatment for diabetes or pancreatic enzyme capsules to help digest food afterwards. Your team will explain your individual risks and recovery plan. [2]
If surgery is unsuitable
Expert centres may consider endoscopic ultrasound guided radiofrequency ablation, which destroys the tumour using heat, for selected small insulinomas. Evidence about long term outcomes remains limited. [1]
For medicines, treatment when an insulinoma has spread, and follow up, see Insulinoma treatments.
Full references
[1] Hofland J, Falconi M, Christ E, et al. European Neuroendocrine Tumor Society 2023 guidance paper for functioning pancreatic neuroendocrine tumour syndromes. Journal of Neuroendocrinology. 2023;35(8):e13318. Question 6.
https://doi.org/10.1111/jne.13318
[2] The Royal Marsden NHS Foundation Trust. Having pancreatic surgery. Patient information booklet GI-0853-05. Revised January 2025, pp. 2–6. Supplementary explanations of operations and risks.
Read the patient information booklet.
[3] Neuroendocrine Cancer UK. Treatment: Neuroendocrine Cancer – Surgery. 2023. “Robotic”, PDF page 5. General information about surgical approaches.
Read the NCUK surgery guide.
[4] Royal Free London NHS Foundation Trust. Minimally invasive robotic liver, pancreas and biliary (HPB) surgery. Leaflet RFL1137, version 1. Approved 14 November 2024.
Read the robotic surgery patient leaflet.
[5] Yin ZZ, Gao YX, Zhao ZM, Hu MG, Tang WB, Liu R. Robotic versus laparoscopic surgery for sporadic benign insulinoma: Short- and long-term outcomes. Hepatobiliary & Pancreatic Diseases International. 2024;23(4):399–405. Published online 3 July 2023.
https://doi.org/10.1016/j.hbpd.2023.06.012
Updated 27 September 2026.