A Spleen-Preserving Approach Using Partial Splenectomy for Pancreatic Tail Lesions: A Video Case Report

This video demonstrates a robotic distal pancreatectomy with partial splenectomy for a pseudopapillary neoplasm located at the splenic hilum. Total splenectomy during distal pancreatectomy carries a lifelong risk of overwhelming post-splenectomy infection. Although splenic preservation is preferred, tumors adjacent to the splenic hilum often preclude standard vessel-sparing techniques.

A 38-year-old woman presented with an incidentally discovered asymptomatic 4-cm pancreatic tail mass during abdominal imaging. Further investigations with endoscopic ultrasound demonstrated a 33-mm pancreatic tail lesion, and fine-needle aspirate cytology was consistent with a pseudopapillary neoplasm. Due to the splenic-artery small-vessel branching, a splenic vessel-sparing Kimura technique was not feasible. A robotic approach using the da Vinci X platform was used. This involved division of the pancreas, ligation of the splenic vessels, and a partial splenectomy. Indocyanine green fluorescence imaging was used to confirm robust perfusion of the preserved splenic segment.

The robotic approach allowed for excellent visualization and precise dissection of the splenic hilum. The patient tolerated the procedure well and experienced an uneventful postoperative recovery. Final pathologic assessment confirmed a pseudopapillary neoplasm with negative margins.

Robotic spleen-preserving distal pancreatectomy with partial splenectomy is a safe and feasible approach for select pancreatic tail lesions near the splenic hilum. This technique achieves oncologic resection and maximizes splenic function when standard vessel-sparing techniques are inappropriate¹.