Robotic left gastric vein reimplantation to prevent gastric venous congestion in total pancreatectomy

Gastric venous congestion (GVC) is a significant but often underrecognized complication of total pancreatectomy (TP). Although left gastric vein (LGV) reimplantation can prevent GVC, its feasibility in robotic surgery has not previously been described. We report our initial experience with LGV reimplantation in three TP cases. In one case, conversion to open surgery was required prior to LGV reimplantation. In this patient, despite patency of the reconstructed LGV, GVC developed and necessitated total gastrectomy due to rapidly worsening lactate acidosis and hemodynamic instability. In the remaining two cases, robotic LGV reimplantation was completed successfully, with immediate gastric decompression and uneventful postoperative recovery. These findings highlight the potential clinical relevance of GVC and demonstrate that robotic assistance enables LGV reimplantation, even in anatomically challenging settings. This experience broadens the scope of vascular reconstruction in robotic pancreatic surgery and supports the expanding role of minimally invasive approaches in managing complex surgical scenarios.