ROBOTIC LEFT-SUBTOTAL SPLENOPANCREATECTOMY FOR A PANCREATIC NECK CARCINOMA COMPRESSING THE SPLENOMESENTERIC CONFLUENCE

Background: The last evolution of robotic system, the da Vinci Xi, has some intrinsic technical improvements that allow an easier and faster surgery in challenging procedures, such as pancreatic resections. We present a case of a left subtotal splenopancreatectomy for a solid mass of the body of the pancreas, in contact with the splenomesenteric confluence, performed with the da Vinci Xi. Methods: A 78-years old man with an incidental finding of a lesion of the neck of the pancreas was operated with the da Vinci Xi platform. The preoperative CT scan confirmed the location of the lesion just above the spleno-mesenteric confluence. For the procedure, we used the upper quadrants trocars disposition suggested by Intuitive. Results: We performed the sub-total splenopancreatectomy totally robotic, with careful isolation and dissection of the lesion from the spleno-portal-mesenteric confluence, which was compressed but not infiltrated. Pancreas was transected at gastroduodenal artery level. The procedure was completed in 350 minutes and no conversion or intra-operative complications were recorded. The postoperative course was uneventful and the patient was discharged on the 7th postoperative day. Conclusions: The da Vinci Xi gives some advantages in pancreatic resections, allowing to perform challenging procedures with a minimally invasive technique, such as in cases of lesions close to the vessels. These advantages could improve the widespread of minimally invasive surgery for the treatment of pancreatic disease.