Background : The safety and oncological effectiveness of minimally invasive spleen-preserving vessel-preserving distal pancreatectomy (SVPDP) for pancreatic neuroendocrine tumors (pNETs) is still debated. Nonetheless, many studies have shown satisfying postoperative and oncological outcomes. A recent clinical trial showed non-inferiority of the robotic access for distal pancreatectomy. However, few studies deeply investigated robotic SVPDP.

Methods : A 51 year old male patient with incidental finding of 2cm solid lesion of the pancreas tail came to our outpatient clinic. Pre-operative CT-scan showed a nodule presenting the typical features of pNET, with a preoperative EUS-guided biopsy confirming a low-grade non-functioning pNET. Multidisciplinary discussion decided for surgery.

Results : After a negative exploration of the abdominal cavity, the gastrocolic ligament was opened to access the epiploic retrocavity. Indocyanine-green (ICG) fluorescence was i.v. injected to better visualize the splenic vessels, that were carefully identified and isolated. The superior and inferior borders of pancreas were identified. A retropancreatic tunnel was created along the confluence between SMV and PV. IOUS were performed to confirm the position of the lesion and the relationship with the vessels. A bulldog clamp was placed on the splenic artery. The pancreas was mobilized and transected with the aid of harmonic scalpel, preserving the splenic vessels. A tubular drain was placed. The patient was discharged after 7 days, with no postoperative complications.

Conclusions : SVPDP can be safely performed through robotic access.