Robotic distal pancreatectomy for a neuroendocrine tumor in an 11-year-old child

Introduction: Over the past decade, robotic pancreatic surgery has gained popularity. Although anatomically comparable, the small size of pediatric patients might impede the use of the surgical robot due to the size of the robotic arms. Pediatric pancreatic resection is rarely indicated, hence only few cases of pediatric robotic pancreatic resection have been described (Hagendoorn et al., 2018; Lalli Raj, 2019-4) [1,2]. To the best our knowledge, no video literature exists on robotic pediatric pancreatic tail resections. Aim of this video was to demonstrate the set-up and surgical technique of robotic distal pancreatectomy in a child.

Methods: This video illustrates fully robotic distal pancreatectomy in an eleven-year-old child. The patient had a past medical history of tuberous sclerosis complex. On surveillance imaging a non-functional neuroendocrine tumor was detected in the pancreatic tail for which a distal pancreatectomy was indicated.

Results: After general anesthesia, the patient was placed in supine position on a split-leg table in anti-Trendelenburg. Four robotic trocars were placed and the da Vinci Xi robotic system was docked. Two laparoscopic assistant ports were placed. A spleen-preserving distal pancreatectomy was performed. Postoperative recovery was unremarkable and the patient was discharged on postoperative day 6.

Conclusion: This video illustrates robotic distal pancreatectomy in an eleven-year-old child. Meticulous port placement, adjusted to the patient's habitus, is an essential element.