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Page 2 of 10 Kauffmann et al. Mini-invasive Surg 2020;4:54 I http://dx.doi.org/10.20517/2574-1225.2020.46

have a malignant tumor. Taken altogether these results suggest that patients requiring these procedures should be
preferentially referred to specialized centers.

Keywords: Robotic, robot, pancreas, spleen, distal, pancreatectomy, preserving

INTRODUCTION
Based on current evidence, and recommendations, a minimally invasive approach should be offered to
[1]
patients with benign or borderline tumors located in the body-tail of the pancreas . Actually, in recent
years, distal pancreatectomy gained so much popularity as to be considered the “standard of care” by some
authors for resectable pancreatic tumors located in the distal part of the pancreas .
[2]
Little doubt exists that the spleen should be preserved, whenever oncologically indicated and anatomically
[3-5]
[5,6]
possible, to reduce the rate of infective and thromboembolic complications , and to improve blood
[7]
supply to the proximal part of the stomach . During distal pancreatectomy the spleen can be preserved
[8]
along with the splenic vessels (Kimura technique) or with en-bloc removal of the splenic vessels (Warshaw
[9]
technique) .
The da Vinci Surgical System® (Intuitive Surgical Inc. Sunnyvale, CA, USA) is a telemanipulator that
faithfully transmits the movements of surgeon’s hands to the miniaturized tips of intracorporeal
[10]
instruments with seven degrees of freedom . Thanks to this tremendous technological improvement, as
well as to some other advances, the da Vinci robot was shown to improve surgical dexterity in minimally
invasive procedures . Based on this background the use of the da Vinci robot seems to be particularly
[11]
rewarding when the spleen and the splenic vessels must be preserved during distal pancreatectomy. We
herein present our series of robot-assisted spleen preserving distal pancreatectomy (RA-SPDP).

METHODS
A retrospective analysis of a prospectively maintained database was performed to identify patients who
were selected for RA-SPDP and received this procedure between April 2008 to July 2019 at a single
Institution (Division of General and Transplant Surgery, University of Pisa). Data were collected and
analyzed according to the Strengthening the Reporting of Observational studies in Epidemiology guidelines
[12]
for observational studies .
Patient selection
Indications to distal pancreatectomy with spleen preservation was established by a multidisciplinary
team, annually managing several hundreds of patients with pancreatic diseases. Distal pancreatectomy
with spleen preservation was considered in patients with benign tumors causing symptoms or in patients
with tumors of low malignant potential located in the body-tail of the pancreas. A minimally invasive
approach was considered in each patient unless obviously impossible. A robotic approach was considered
whenever the robot was timely available. Alternatively, patients received a laparoscopic procedure.
Absolute contraindications to RA-SPDP were thrombosis of the splenic vein, tumors size exceeding 15 cm,
concurrent splenic disease, and concerns on tumor type.

All patients underwent standard preoperative work-up and were assigned to one of the risk categories
[13]
defined by the American Society of Anesthesia . Pancreatic tumors were studied extensively using a
combination of laboratory and imaging studies as required by the individual case until a final diagnosis
was agreed upon by a group of experts, including surgeons, oncologists, and radiologists. Endoscopic
ultrasound, with fine needle aspiration cytology or biopsy, was also employed as required.