Intraoperative ultrasound revealing a focal lesion on a child's pancreas during surgery.

Intraoperative Ultrasound: The Surgeon's Sixth Sense in Congenital Hyperinsulinism

Soraya Malik in Health & Wellness September 2025 • 4 min read.

"Discover how real-time ultrasound is revolutionizing tissue-sparing surgery for children with congenital hyperinsulinism, minimizing complications and maximizing cure rates."

Congenital hyperinsulinism (CHI) is a rare genetic disorder where the pancreas secretes too much insulin, leading to persistent hypoglycemia, especially in infants. This condition can cause seizures, brain damage, and developmental delays if not promptly and effectively treated. The challenge lies in identifying and removing only the affected part of the pancreas, preserving as much healthy tissue as possible.

Traditionally, surgeons relied on preoperative imaging and intraoperative palpation (feeling with their hands) to locate problematic areas within the pancreas. However, these methods can be imprecise, particularly when the lesions are small or deep within the tissue. Removing too much of the pancreas can lead to diabetes later in life, making precise surgery critical.

Enter intraoperative ultrasound (IOUS), a real-time imaging technique that allows surgeons to visualize the pancreas during the operation. Think of it as a surgeon's sixth sense, providing a live view of what lies beneath the surface. This technology promises to enhance the precision of tissue-sparing surgery, improving outcomes for children with focal CHI.

How Does Intraoperative Ultrasound Change the Game?

Intraoperative ultrasound revealing a focal lesion on a child's pancreas during surgery.

A recent study published in "Frontiers in Endocrinology" investigated the use of IOUS in guiding surgical resections for children with focal CHI. Researchers at Odense University Hospital in Denmark conducted a retrospective analysis of 24 patients with focal CHI who underwent surgery between 2010 and 2017. All patients had confirmed focal lesions via genetic testing and 18F-DOPA-PET/CT scans.

The results highlight the potential of IOUS to refine surgical precision:

Enhanced Localization: IOUS successfully located the focal lesion in 16 out of 20 patients (80% sensitivity).
Improved Specificity: IOUS correctly identified the absence of focal lesions in all 11 patients with diffuse CHI (100% specificity).
Tissue-Sparing Success: Guided by IOUS, surgeons performed tissue-sparing resections in 67% of patients, removing only the affected tissue.
Ectopic Lesion Detection: IOUS aided in locating an ectopic lesion (a lesion outside the normal location) in the duodenal wall, a rare occurrence that can be challenging to identify.

Importantly, the study also found that IOUS, combined with preoperative imaging and intraoperative frozen section analysis (examining tissue under a microscope during surgery), resulted in a 100% cure rate for hypoglycemia. Moreover, patients who underwent tissue-sparing resections experienced fewer early postoperative complications compared to those who had larger resections.

The Future of CHI Surgery

This study adds to the growing body of evidence supporting the use of IOUS as a valuable tool in CHI surgery. By providing real-time visualization, IOUS enables surgeons to perform more precise and less invasive resections, leading to better outcomes for children with this challenging condition. The combination of genetics, advanced imaging, and innovative surgical techniques offers new hope for a future where CHI can be effectively managed with minimal long-term consequences.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.3389/fendo.2018.00478, Alternate LINK

Title: Intraoperative Ultrasound: A Tool To Support Tissue-Sparing Curative Pancreatic Resection In Focal Congenital Hyperinsulinism

Subject: Endocrinology, Diabetes and Metabolism

Journal: Frontiers in Endocrinology

Publisher: Frontiers Media SA

Authors: Julie Bendix, Mette G. Laursen, Michael B. Mortensen, Maria Melikian, Evgenia Globa, Sönke Detlefsen, Lars Rasmussen, Henrik Petersen, Klaus Brusgaard, Henrik T. Christesen

Published: 2018-08-22

Everything You Need To Know

What is Congenital hyperinsulinism (CHI)?

Congenital hyperinsulinism (CHI) is a rare genetic disorder where the pancreas produces excessive insulin. This overproduction leads to persistent hypoglycemia, which can cause seizures, brain damage, and developmental delays, particularly in infants. The primary treatment goal is to remove the affected pancreatic tissue while preserving healthy tissue to prevent diabetes.

What is intraoperative ultrasound (IOUS)?

Intraoperative ultrasound (IOUS) is a real-time imaging technique used during surgery. It allows surgeons to visualize the pancreas and identify areas affected by focal Congenital hyperinsulinism (CHI). This real-time view enhances the precision of tissue-sparing surgery by guiding the resection of only the problematic tissue, thus minimizing the removal of healthy pancreatic tissue.

Why is intraoperative ultrasound (IOUS) important in the treatment of Congenital hyperinsulinism (CHI)?

IOUS is significant because it improves surgical precision in treating Congenital hyperinsulinism (CHI). Traditional methods like palpation are less precise, especially with small or deep lesions. IOUS helps surgeons locate lesions accurately, enabling tissue-sparing resections. This precision reduces the risk of removing too much healthy tissue, which could lead to diabetes, and improves overall patient outcomes.

What are the implications of using intraoperative ultrasound (IOUS) in CHI surgery?

The implications of using IOUS are substantial. By enhancing the ability to perform tissue-sparing surgery, IOUS leads to fewer postoperative complications and a higher cure rate for Congenital hyperinsulinism (CHI). The ability to locate and remove only the diseased tissue reduces the likelihood of long-term issues like diabetes, thus improving the quality of life for children with CHI. IOUS, combined with other techniques, offers a promising future for managing CHI with minimal long-term consequences.

What is meant by tissue-sparing surgery in the context of Congenital hyperinsulinism (CHI)?

In the context of treating Congenital hyperinsulinism (CHI), tissue-sparing surgery involves the removal of only the diseased portion of the pancreas. This is crucial because removing too much pancreatic tissue can lead to diabetes. IOUS enables this approach by providing real-time visualization during surgery, allowing surgeons to precisely target and remove only the affected area, thus preserving as much healthy pancreatic tissue as possible.