Seeing Beneath the Surface: Neuroendocrine Tumor Localization

Posted by BK Medical on Jan 4, 2024 7:46:24 AM

The Use of Intraoperative Ultrasound During a Robotic Caudal Pancreatectomy with Splenic Preservation

A neuroendocrine tumor (NET) is a rare type of tumor that can occur anywhere in the pancreas. Diagnosis and treatment of NETs depend on the type of tumor, its location, whether it produces excess hormones, how aggressive it is and whether it has spread to other parts of the pancreas.1

Dr. Marcos Belotto, Robotic Surgery Specialist at Celebration Florida Hospital, recently used a bk5000 ultrasound system during a pancreatic surgery case to help him locate a neuroendocrine tumor. Dr. Belotto has a PhD in Surgery from Hospital Sírio Libanês and a Masters of Surgery from Santa Casa de São Paulo. With a focus in pancreas and liver surgery and 10 years of experience using robotic and laparoscopic intraoperative ultrasound (iUS), Dr. Belotto has performed more than 700 robotic surgeries throughout Brazil and is a pioneer in hepatobiliary pancreatic robotic surgery in Latin America.


Read on to see what Dr. Belotto had to say about using a bk5000 ultrasound system during this case.

During a routine ultrasound exam, a 27-year-old female patient was found to have a 2-centimeter hypervascular nodule in the tail region of the pancreas. With no signs of weight loss or abdominal pain, a biopsy was performed by echoendoscopy. An anatomopathological examination showed compatibility with a well-differentiated Ki67 2% neuroendocrine tumor. Given the young age of the patient, we decided to perform a robotic caudal pancreatectomy with splenic preservation. It is important to note that splenic preservation was chosen because of the immune function of the spleen over an individual's lifetime, especially during the first decades.

The use of robotic ultrasound was necessary during this case both to localize the tumor and the relationship of the tumor with pancreatic and splenic vessels. It was essential for the precise location of the intrapancreatic nodule and for performing pancreatic parenchyma-preserving surgery, with a margin of safe tumor resection. At the end of the resection, it was possible to evaluate the blood flow of the splenic artery and vein using Doppler.

From an anatomical point of view, it is known that anatomical variations in [the pancreas] are common. Therefore, the use of iUS allows for additional confidence and safety during surgery. 

Dr. Belotto leveraged the high-resolution image quality from iUS to help locate and visualize anatomical structures like benign and malignant lesions, key arteries, and veins. It's through the use of iUS that he has noticed benefits and can perform surgeries with confidence, confirmation, and clarity at every step of his pancreatic procedures.

To learn more about BK Medical’s robotically controlled intraoperative imaging tools, visit

1 National Comprehensive Cancer Network: NCCN Guidelines for Patients® Neuroendocrine Tumors. 

Topics: Robotic-Assisted Surgery, Active Imaging, Intraoperative Ultrasound, bk5000, General Surgery, Pancreas

Written by BK Medical