Robotic spleen preserving distal pancreatectomy

in pediatric patient.

Case report

Young Ju Hong M.D., Seonae Ryu, Hye Kyung Chang M.D., Jung Tak Oh M.D., Seok Joo Han M.D.

Department of Pediatric SurgerySeverance Children`s Hospital

Department of SurgeryYonsei University College of Medicine

Yonsei University Health System

Background

Solid papillary neoplasm rare pancreatic neoplasm (1~3% of primary pancreatic tu-

mors)

>80% : female, 85% : less than 30 years old

With surgical complete excision 5 YSR : 95 %

Aggressive variants : represent malignant degeneration in an otherwise indolent tumor

Surgical resection is indicated in all instances

Yonsei University Health System

Background

Minimally invasive surgery for pancreatic tumor 1996 first laparoscopic distal pancreatectomy

Low grade tumor, young patient : choice

Splenic preservation : useful, especially in children

da Vinci robot system 3D magnified field of view Precise and multi-articulated handlike motions Hand-tremor filtering system Ergonomically designed operative space

Case – History of illness

F/16

C.C : low abdominal pain (duration : 2 weeks)

Laboratory test

4800(33%) 12.5/37.4 308K

Amylase/lipase 74/25

CEA 0.91

CA 19-9 1.5

Yonsei University Health System

Case – MRI

Case – MRI

Case – PET CT

Case – Operation

Case – Pathology

Solid pseudopapillary tu-mor– size : 1x0.8cm– Mitosis : 3/10 HPF– LVI : not identified– Resection margin : free from tumor

IH stain– Vimentin and beta-catenin

: positive – CD 10 : focally and weakly

positive– Chromogranin A : Negative

Case – Progress

POD 2 : gas out(+), SOW POD 4 : soft diet POD 5 : Lab : WNL, CT POD 8 : discharge

Robotic spleen preserving distal pancreatectomy in pediatric patient

Safe Feasible treatment option that preserves splenic function

for benign or low grade malignant tumor of the distal pancreas

Yonsei University Health System

Conclusion

Thank you for your attention