Introduction : With the introduction of the da Vinci robotic system, preliminary case series have suggested an improved spleen preservation rate versus the standard laparoscopic approach. Splenic vessel-preservation (Kimura procedure) allows perfusion of the spleen with its native vasculature. This approach can be technically challenging given it requires dissecting the pancreas from the splenic vessel which may be closely adherent. We described robotic distal pancreatectomy (RDP) with splenic vessel preservation.

Methods : We report a case of a 58-year-old female with size growing cystic mass in the distal pancreas. Using da Vinci Xi systetm, total 5 ports (8mm x4 for robotic carmera and arm, and 12mm x1 for assistant) were applied to patient. Robotic instruments include a cardier forceps in arm 1, Maryland bipolar forceps in arm 2, and monopolar cautery hook dissector and Harmonic ace in arm 3.

Results : The splenic artery and vein were carefully freed and fully identified with meticulous approach. A Robotic metal clip and Harmonic scalpel were used to clear away fatty tissue and small vessels. EndoGIA stapler was used to transect the body of the pancreas through assistant port. Intraoperative blood loss was minmial and operating time was 150 min including 105 min of console time. The patient had an uncomplicated recovery.

Conclusions : The spleen-preserving RDP has demonstrated feasibility and safety because the higher magnification and three-dimensional visualization as well as the wrist-like instrumentation of the robotic instruments were key elements in enabling us to carefully dissect the splenic vessels off the distal pancreas and preserve the spleen.