A New Robotic Technique to Facilitate Distal Pancreatectomy with Preservation of Splenic Vessels: Left Lateral Approach in Right Lateral Decubitus Position

Abstract

Introduction: Spleen-preserving distal pancreatectomy (SPDP), with or without splenic vessel preservation, is the technique of choice for patients with benign or small low-grade malignant tumours of the body or tail of the pancreas, as it avoids the potential side effects of splenectomy. Furthermore, splenic vessel-preserving distal pancreatectomy (SVPDP) is the ideal procedure although it is technically demanding, even when performed by open surgery. In order to simplify the preservation of the splenic vessels, different open and laparoscopic approaches have been described in the literature. Methods: In this article, we describe a new variation in surgical technique performed at our centre: robotic left-lateral approach SVPDP in right lateral decubitus position, in a patient with a solid and pseudopapillary neoplasm (SPN) of the pancreatic tail. Results: Recent publications have shown a higher splenic preservation rate in robotic distal pancreatectomy when compared to the laparoscopic approach. Our experience shows that the robotic approach might facilitate this procedure and shorten hospital stay. Conclusions: The robotic left lateral approach-SVPDP in the right lateral decubitus position is a feasible and safe approach for distal benign or small low-grade malignant tumours of the pancreatic tail. The right lateral decubitus position associated with robotic assistance can facilitate this complex procedure with a lower risk of conversion and shorten the learning curve.