A Spleen-Preserving Approach Using Partial Splenectomy for Pancreatic Tail Lesions: A Video Case Report.

BACKGROUND: This video demonstrates a robotic distal pancreatectomy with partial splenectomy for a pseudopapillary neoplasm located at the splenic hilum. Total splenectomy during distal pancreatectomy carries a lifelong risk of overwhelming post-splenectomy infection. Although splenic preservation is preferred, tumors adjacent to the splenic hilum often preclude standard vessel-sparing techniques. METHODS: A 38-year-old woman presented with an incidentally discovered asymptomatic 4-cm pancreatic tail mass during abdominal imaging. Further investigations with endoscopic ultrasound demonstrated a 33-mm pancreatic tail lesion, and fine-needle aspirate cytology was consistent with a pseudopapillary neoplasm. Due to the splenic-artery small-vessel branching, a splenic vessel-sparing Kimura technique was not feasible. A robotic approach using the da Vinci X platform was used. This involved division of the pancreas, ligation of the splenic vessels, and a partial splenectomy. Indocyanine green fluorescence imaging was used to confirm robust perfusion of the preserved splenic segment. RESULTS: The robotic approach allowed for excellent visualization and precise dissection of the splenic hilum. The patient tolerated the procedure well and experienced an uneventful postoperative recovery. Final pathologic assessment confirmed a pseudopapillary neoplasm with negative margins. CONCLUSION: Robotic spleen-preserving distal pancreatectomy with partial splenectomy is a safe and feasible approach for select pancreatic tail lesions near the splenic hilum. This technique achieves oncologic resection and maximizes splenic function when standard vessel-sparing techniques are inappropriate1.