Clinical application of robotic spleen preserving distal pancreatectomy for children with pancreatic neoplasm of the body and tail

Objective To explore the safety and feasibility of robotic spleen preserving distal pancreatectomy with conservation of spleen vessels for children who suffered from benign or low-grade malignant pancreatic tumor of the body and tail. Methods From July 2016 to October 2018, 2 children with benign or low-grade malignant pancreatic tumor of the body and tail underwent Da Vinci robotic distal pancreatectomy with conservation of splenic vessels. Case 1 was a 9-year-old girl who suffered from insulinoma with weight of 24 kg and height of 120 cm. Case 2 was a 11-year-old girl who suffered from solid pseudopapillary tumor with weight of 35.5 kg and height of 154 cm. Intraoperative indicators and clinical outcomes were assessed. Results The operating time was 155 minutes and 150 minutes, respectively, and the pneumoperitoneum time was 120 minutes. The intraoperative blood loss was 10 ml and 50 ml, respectively. They experienced uneventful recovery postoperatively, without pancreatic fistula, bleeding and infection, et al. No complications related to pneumoperitoneum occurred. The blood glucose in the girl suffered from insulinoma was restored to a normal level, with a ratio of fasting insulin to glucose less than 0.4. She was followed up for 2.25 years, without tumor recurrence.The girl suffered from solid pseudopapillary tumor took low fat diet without abdominal discomfort. Conclusion Robotic spleen preserving distal pancreatectomy with conservation of spleen vessels is safe and feasible for children who suffered from benign or low grade malignant pancreatic tumor of the body and tail. Limited distal pancreatectomy should be a principle for this surgery.