Robot-assisted Laparoscopic Central Pancreatectomy with Pancreaticogastrostomy (Transgastric Approach)

The pancreatic surgeons need to consider patients’ quality of life when treating benign and borderline malignant tumor of the pancreas because the patients’ long-term survival is highly expected following successful pancreatectomy. Ideally, function-preserving minimally invasive surgery is thought to be quite adequate approach for them. Pancreaticoduodenectomy (PD) or extended distal pancreatectomy (EDP) with splenectomy was traditional treatment option for the benign and borderline malignant tumors locating in the pancreatic neck portion. Central pancreatectomy (CP) was just selectively applied in the past because of its frequent combined-morbidity.1, 2 Recently, revisiting role of CP seems to be lightened by several authors.1-5 With the development of laparoscopic experiences and instruments, only a few reports of conventional laparoscopic central pancreatectomy have been published by some expert surgeons6-7. However, the several disadvantages of conventional laparoscopic surgery, such as limited range of motion, fulcrum effect and twodimensional operative view, could not encourage liberal attempts of various pancreas surgeries. Recent advances in computer technology are providing surgical robot system especially with multi-articulated joint and three-dimensional (3-D) operating view9. This surgical system is thought to provide more precise, safe, and effective laparoscopic performance, which might result in expanding the indication for minimally invasive surgery in benign and borderline malignant tumors of pancreas. Herein, we demonstrate a case of robot-assisted laparoscopic central pancreatectomy with pancreaticogastrostomy (transgastric approach) in neuroendocrine tumor of the pancreas locating in neck of the pancreas and briefly discuss the feasibility and benefit of this procedure.