Robotic Distal Pancreatectomy for Intraductal Oncocytic Papillary Neoplasm

Abstract

Robotic distal pancreatectomy has become an established approach for the management of pancreatic body and tail lesions, offering enhanced dexterity, improved visualization, and refined dissection around critical vascular structures.

A 55-year-old man with hypertension, a history of smoking, and chronic alcohol abuse presented with progressive upper abdominal pain and postprandial bloating. MRI and CT identified a 7-cm multicystic lesion in the pancreatic body with thin septations and apparent communication with the main pancreatic duct, suggestive of a branch-duct intraductal papillary neoplasm. Multidisciplinary discussion recommended a robotic spleen-preserving distal pancreatectomy.

The procedure included access to the lesser sac, gastric suspension for exposure, careful dissection of the inferior pancreatic border, and preservation of the splenic vessels. Pancreatic transection was performed using an Endo GIA™ reinforced reload introduced through the AirSeal port. A targeted hemostatic suture was placed in friable parenchyma adjacent to the transection line, followed by Hemopatch application and placement of a silastic drain.

Splenic vessel patency and perfusion of the pancreatic remnant were confirmed using indocyanine green fluorescence and Doppler ultrasound.

The patient was discharged on postoperative day four with no pancreatic fistula. Final pathology revealed an intraductal oncocytic papillary neoplasm with high-grade dysplasia and negative margins (pTisN0M0). Multidisciplinary consensus recommended postoperative surveillance.

Robotic distal pancreatectomy allows safe vessel preservation, controlled pancreatic transection, and excellent postoperative outcomes in patients with complex pancreatic cystic lesions.