Robotic Distal Splenopancreatectomy and Left Nephrectomy: Double Docking for En Bloc Resection of Pancreatic Cancer

Robotic approach has been demonstrated as a safe option for selected patients undergoing left pancreatectomy.¹ Nevertheless, robotic approach is still uncommon in case of multivisceral resections involving the pancreas.^2,3 We describe a reproducible distal splenopancreatectomy with en bloc left kidney resection for the treatment of pancreatic cancer.

An 81-year-old male patient was diagnosed with adenocarcinoma in the tail of the pancreas with renal infiltration. After completing neoadjuvant therapy with Gem-Abraxane, with a good response, a decision was made to perform resective surgery using a robotic approach. The teams of urology and pancreatic surgery collaborated to perform the procedure. The approach prioritized an en bloc resection with negative margin. Early identification of the renal hilum and kidney mobilization from the inferior and lateral margin facilitated further en bloc mobilization.

Following partial kidney mobilization, the patient's position and trocar placement were modified. The splenic artery was sectioned, and the pancreatic body was mobilised. It was then sectioned to the left of the pancreatic neck, together with the splenic vein, using an endostapler. Finally, the pancreatic tail, upper renal pole, and spleen were mobilized en bloc without detaching the three organs. The patient was discharged on postoperative day 6. Pathology results showed a T4 pancreatic adenocarcinoma with kidney invasion and two out of 26 lymph nodes involved.

The involvement of a multidisciplinary team and the option of re-docking in complex robotic procedures reduces the conversion risk and offers patients benefits by ensuring oncological radicality.