ASO Author Reflections: Patient Selection and Technique for Robotic Spleen-Preserving Distal Pancreatectomy

Spleen-preserving distal pancreatectomy is an increasingly preferred approach for patients with multiple endocrine neoplasia type 1 (MEN1) and pancreatic neuroendocrine tumors (pNETs), offering potential long-term benefits, such as preserved immunologic function and reduced thromboembolic or oncologic risks. While traditional distal pancreatectomy with splenectomy facilitates lymph node clearance, it carries significant short- and long-term complications. In our recently published video, we demonstrate a robotic spleen-preserving distal pancreatectomy using the Kimura technique in two patients with MEN1 and multifocal pNETs. Key technical principles include precise splenic vessel skeletonization, dissection of hilar lymph nodes, and preservation of short gastric vessels. The robotic platform facilitates safe and meticulous perivascular dissection. Future directions include prospective studies on long-term outcomes and expanding access to spleen-preserving techniques through surgical training and standardized approaches. For appropriately selected patients, spleen preservation may optimize oncologic safety while maintaining physiologic immune function.