Robotic Pancreaticoduodenectomy in Pediatric Patients: First Two Reported Cases in the United States.

BACKGROUND: Pancreaticoduodenectomy (Whipple procedure) is rarely required in children, but remains the standard of care for resectable pancreatic head tumors. Robotic pancreaticoduodenectomy (RPD) has been increasingly performed in adults, demonstrating safety, feasibility, and in some series, superior perioperative outcomes compared with open surgery. In children, however, there are only three published case reports worldwide. METHODS: We describe two adolescent females with pancreatic head solid pseudopapillary neoplasms (SPNs) who underwent RPD at high-volume U.S. CENTERS: Both cases were managed by multidisciplinary teams including pediatric surgeons and adult surgical oncologists experienced in robotic pancreatic surgery. RESULTS: Case 1: A 13-year-old underwent robotic pylorus-preserving pancreaticoduodenectomy utilizing intraoperative Indocyanine Green Firefly and ultrasound to assess critical anatomy. Reconstruction was performed with Blumgart pancreaticojejunostomy and hepaticojejunostomy. She advanced to diet by postoperative day (POD) 3 and was discharged on POD 3. Case 2: A 17-year-old underwent RPD with pylorus preservation in a similar fashion at an adult hospital. Her recovery was uncomplicated, drains were removed on POD 4, and she was discharged on POD 5. Final pathology in both patients confirmed SPN with negative margins. CONCLUSIONS: These represent the first pediatric RPDs reported in the United States and the first using the da Vinci Xi platform. Our experience demonstrates that pediatric RPD is feasible and safe when performed in collaboration with high-volume adult robotic pancreatic programs. Given the rarity of pediatric pancreatic tumors, collaborative registries and continued reporting are essential to define outcomes and guide best practice.