Robot-assisted spleen-preserving laparoscopic distal pancreatectomy

Spleen-preserving laparoscopic distal pancreatectomy would be an ideal approach for benign and borderline malignant tumors in the distal pancreas.1 However, this procedure requires advanced surgical experience and technique because of the disadvantages of conventional laparoscopic surgery.2

A 35-year-old female patient visited our institution because of a growing pancreatic mass during follow-up. A preoperative image study showed a cystic tumor of about 3.0 × 2.5 cm in size in the body of the pancreas. Under the impression of a growing serous cystic tumor of the pancreas, she was scheduled to undergo robot-assisted spleen-preserving laparoscopic distal pancreatectomy.

Under general anesthesia, the patient was placed in the supine position with her head and left side elevated. A total of five ports were used. Among them, one 12-mm port was placed for the assistant surgeon's intervention during the procedure. Stable 3-dimensional operative image, endo-wrist function of the instruments, and no tremor were thought to be very helpful for fine dissection of the pancreas from splenic vessels. The total operation time was 300 min, and the estimated intraoperative blood loss was 380 ml. No transfusion was required. The patient's postoperative recovery was uneventful. She was able to go home on the 6th postoperative day without a drain.

The unique characteristics of a robotic surgical system were thought to be very helpful during the spleen-preserving laparoscopic distal pancreatectomy.2 (-) 6 However, cost is one of the main obstacles for the procedure's popular clinical practice.2.