ORIGINAL ARTICLE – PANCREATIC TUMORS

Robot-Assisted Spleen-Preserving Laparoscopic DistalPancreatectomy

Sung Hoon Choi, MD1,2, Chang Moo Kang, MD1,2, Woo Jung Lee, MD1,2, and Hoon Sang Chi, MD1,2

1Division of Hepatobiliary and Pancreas, Department of Surgery, Yonsei University College of Medicine, Seoul, Korea;2Pancreaticobiliary Cancer Clinic, Institute of Gastroenterology, Clinic of Bilio-Pancreas, Yonsei University Health

System, Seoul, Korea

ABSTRACT

Background. Spleen-preserving laparoscopic distal pan-

createctomy would be an ideal approach for benign and

borderline malignant tumors in the distal pancreas.1

However, this procedure requires advanced surgical expe-

rience and technique because of the disadvantages of

conventional laparoscopic surgery.2

Methods. A 35-year-old female patient visited our insti-

tution because of a growing pancreatic mass during follow-

up. A preoperative image study showed a cystic tumor of

about 3.0 9 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.

Results. 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 tre-

mor 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.

Conclusions. The unique characteristics of a robotic sur-

gical 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 proce-

dure’s popular clinical practice.2

ACKNOWLEDGMENT The authors would like to express special

thanks to Dong-Su Jang (Medical Illustrator, Medical Research

Support Section, Yonsei University College of Medicine, Seoul,

Korea) for his help with the figures and to Emily Kim Goldsmith

(English Editor, Medical Research Support Section, Yonsei Univer-

sity College of Medicine, Seoul, Korea) for the comprehensive

narration of this multimedia article.

CONFLICT OF INTEREST None.

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The first Korean experience of telemanipulative robot-assisted

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3. Kang CM, Chi HS, Kim JY, Choi GH, Kim KS, Choi JS, et al. A

case of robot-assisted excision of choledochal cyst, hepaticojej-

unostomy, and extracorporeal Roux-en-y anastomosis using the da

Vinci surgical system. Surg Laparosc Endosc Percutan Tech.2007;17:538–41.

4. Giulianotti PC, Sbrana F, Bianco FM, Addeo P, Caravaglios G.

Robot-assisted laparoscopic middle pancreatectomy. J Laparoen-dosc Adv Surg Tech A. 2010;20:135–9.

5. Giulianotti PC, Sbrana F, Bianco FM, Elli EF, Shah G, Addeo P,

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surgeon experience. Surg Endosc. 2010;24:1646–57.

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resection of left-sided pancreatic ductal adenocarcinoma: evolu-

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Electronic supplementary material The online version of thisarticle (doi:10.1245/s10434-011-1816-y) contains supplementarymaterial, which is available to authorized users.

� Society of Surgical Oncology 2011

First Received: 25 November 2010;

Published Online: 12 June 2011

C. M. Kang, MD

e-mail: cmkang@yuhs.ac

Ann Surg Oncol (2011) 18:3623

DOI 10.1245/s10434-011-1816-y