Robot-assisted spleen-preserving distal pancreatectomy: a single surgeon's experiences and proposal of clinical application.
BACKGROUND
Advanced and delicate laparoscopic techniques are usually required for safe and successful laparoscopic spleen-preserving distal pancreatectomy. The unique characteristics of robotic surgical system are thought to be useful for this minimally invasive procedure.


METHODS
From September 2007 to May 2011, patients who underwent robot-assisted, spleen-preserving, distal pancreatectomy for benign and borderline malignant tumors of the pancreas were retrospectively reviewed. Perioperative clinicopathologic surgical outcomes were evaluated.


RESULTS
Twenty-two patients were attempted for robot-assisted, spleen-preserving, distal pancreatectomy, and in 21 patients (95.5 %), the spleen was saved either by splenic vessels conservation (SVC; n = 17, 81 %) or by splenic vessels sacrifice (SVS; n = 4, 19 %). Seven patients were male and 15 were female with a mean age of 43.2 ± 15.2 years. Pathologic diagnosis included MCT in five patients, SCT in five, SPT in four, IPMT in three, NET in three, and other benign conditions in two. The mean operation time was 398.9 ± 166.3 min, but it gradually decreased as experiences were accumulated (Rsq = 0.223, p = 0.023). Intraoperative blood loss was 361.3 ± 360.1 ml, and intraoperative transfusion was required in four patients (18.1 %). A soft diet was given for 1.2 ± 0.4 days, and the length of hospital stay was 7.0 ± 2.4 days postoperatively. Clinically relevant pancreatic fistula was noted in two patients (9.1 %) but was successfully managed conservatively. Most patients (87.5 %) showed patency in conserved both splenic vessels, and only two patients (12.5 %) had partially or completely obliterated in splenic veins in the SVC-SpDP group. Partially impaired splenic perfusion was observed in one patient in the SVS-SpDP group. The perfusion defect area decreased without any clinical symptom after 4 months.


CONCLUSIONS
The robotic surgical system is thought to be beneficial for improving the spleen-preservation rate in laparoscopic distal pancreatectomy. Robot-assisted approach can be chosen for patients who require spleen-preserving distal pancreatectomy.
Division of Hepatobiliary and Pancreas, Department of Surgery, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, South Korea. DRHHK@yuhs.ac
Ho Kyoung
HK
Hwang
Chang Moo
CM
Kang
Young Eun
YE
Chung
Kyung Ah
KA
Kim
Sung Hoon
SH
Choi
Woo Jung
WJ
Lee
D000328:Adult; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008297:Male; D061646:Operative Time; D059351:Organ Sparing Treatments / Q000379:methods*; D010180:Pancreatectomy / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000601:surgery*; D012189:Retrospective Studies; D012371:Robotics / Q000379:methods*; D013154:Spleen / Q000098:blood supply / Q000601:surgery*; D016896:Treatment Outcome; D014654:Vascular Patency / Q000502:physiology