title: First experience with robotic spleen-saving, vessel-preserving distal pancreatectomy in Singapore: a report of three consecutive cases.
abstract: BACKGROUND
  The use of laparoscopic distal pancreatectomy (LDP) has increased worldwide due to the reported advantages associated with this minimally invasive procedure. However, widespread adoption is hindered by its technical complexity. Robotic distal pancreatectomy (RDP) was introduced to overcome this limitation, but worldwide experience with RDP is still lacking. There is presently evidence that RDP is associated with decreased conversion rate and increased splenic preservation as compared to LDP.
  
  
  METHODS
  We conducted a prospective study on our initial experience with robotic spleen-saving, vessel-preserving distal pancreatectomy (SSVP-DP) between July 2013 and April 2014.
  
  
  RESULTS
  Three consecutive patients underwent attempted robotic SSVP-DP. The indications were a 2.1-cm indeterminate cystic neoplasm, 4.5-cm solid pseudopapillary neoplasm and 1.2-cm pancreatic neuroendocrine tumour. For all three patients, the procedure was completed without conversion, and the spleen, with its main vessels, was successfully conserved. The median total operation time, blood loss and postoperative stay were 350 (range 300-540) minutes, 200 (range 50-300) mL and 7 (range 6-14) days, respectively. Two patients had minor Clavien-Dindo Grade I complications (one Grade A pancreatic fistula and one postoperative ileus). One patient had a Clavien-Dindo Grade IIIa complication (Grade B pancreatic fistula requiring percutaneous drainage). All patients were well at the time of reporting after at least six months of follow-up.
  
  
  CONCLUSIONS
  Our preliminary experience with robotic SSVP-DP confirmed the feasibility of the procedure.
authors.affiliation: Department of Hepatopancreatobiliary and Transplantation Surgery, Singapore General Hospital, Singapore.|Duke-NUS Graduate Medical School, Singapore.
authors.forename: Brian Kp
authors.initials: BK
authors.lastname: Goh
authors.affiliation: Department of Hepatopancreatobiliary and Transplantation Surgery, Singapore General Hospital, Singapore.
authors.forename: Jen-San
authors.initials: JS
authors.lastname: Wong
authors.affiliation: Department of Hepatopancreatobiliary and Transplantation Surgery, Singapore General Hospital, Singapore.
authors.forename: Chung-Yip
authors.initials: CY
authors.lastname: Chan
authors.affiliation: Department of Hepatopancreatobiliary and Transplantation Surgery, Singapore General Hospital, Singapore.|Duke-NUS Graduate Medical School, Singapore.
authors.forename: Peng-Chung
authors.initials: PC
authors.lastname: Cheow
authors.affiliation: Department of Hepatopancreatobiliary and Transplantation Surgery, Singapore General Hospital, Singapore.|Duke-NUS Graduate Medical School, Singapore.|Division of Surgery, Singapore General Hospital, Singapore.
authors.forename: London Lpj
authors.initials: LL
authors.lastname: Ooi
authors.affiliation: Department of Hepatopancreatobiliary and Transplantation Surgery, Singapore General Hospital, Singapore.|Duke-NUS Graduate Medical School, Singapore.
authors.forename: Alexander Yf
authors.initials: AY
authors.lastname: Chung
mesh_terms: D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D059351:Organ Sparing Treatments; D010180:Pancreatectomy / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000601:surgery*; D056888:Patient Positioning; D011446:Prospective Studies; D065287:Robotic Surgical Procedures; D012846:Singapore; D013154:Spleen / Q000601:surgery*; D055815:Young Adult
keywords: da Vinci; laparoscopic; minimally invasive; pancreatectomy; robotic