Annals of Surgical Oncology

, Volume 18, Issue 3, pp 642–643 | Cite as

Robotic Left Pancreatectomy for Pancreatic Solid Pseudopapillary Tumor

  • Dimitrios Ntourakis
  • Ettore Marzano
  • Vito De Blasi
  • Elie Oussoultzoglou
  • Daniel Jaeck
  • Patrick PessauxEmail author
Pancreatic Tumors



Solid pseudopapillary pancreatic tumors of pancreas are a rare entity, seen most often in females in their second or third decades. Although previously believed to be benign, this tumor is currently considered a low-grade malignant epithelial neoplasm with low metastatic rate and high overall survival.1,2 Its resection could be performed by robotic technique with respect to oncological principles to avoid tumor cell dissemination.3


In this multimedia article, we present a 28-year-old female with a history of hyperthyroidism who underwent a computed tomography (CT) scan because of a persistent high C-reactive protein level following caesarean section. This CT scan revealed a 7-cm cystic lesion of the pancreatic tail. The serum tumor marker CA 19-9 was normal. Further investigation with an magnetic resonance imaging (MRI) scan showed that the lesion was macrocystic with internal septas compatible with a solid pseudopapillary neoplasm.4 The patient was treated with robotic distal splenopanceatectomy (video).


The operative time was 5 h with an estimated blood loss of 250 mL. No blood transfusion was necessary. The postoperative period was uneventful, and she was discharged on postoperative day 8. The histological finding revealed a solid pseudopapillary tumor of the pancreas pT2pN0 (0/14 lymph nodes removed). There was no evidence of clinical, biological, and radiological pancreatic fistula, and a control CT scan on postoperative day 8 did not show any abdominal fluid collection. The patient’s 1 month follow-up was normal.


The robotic distal splenopancreatectomy is a procedure that offers some technical and oncological advantages over the already described minimally invasive techniques for distal pancreatic tumors.5,6 These advantages are mainly due to the stability of the operative field, to the 3D and magnified vision, and to the articulated robotic arms.7, 8, 9 The 3D representation and the stability of the operative field facilitate the performance of operative steps, as the creation of the retropancreatic tunnel and vascular identification. Moreover, the robotic articulated arms permit a superior handling of vascular structures, allowing a fine dissection that is extremely useful during lymphadenectomy. Articulated instruments easily achieve the correct rotation axis, thus minimizing peri-pancreatic tissue retraction and manipulation of the pancreatic gland. This smooth and no-touch technique in theory minimizes the risk of pancreatic capsule rupture as well as tumor cell dissemination, respecting oncological surgical standards. However, robotic surgery needs an adequate learning curve, especially concerning the installation and the lack of force feedback.


The robotic distal pancreatectomy is a possible minimally invasive technique for patients with solid pseudopapillary pancreatic tumors. It presents some advantages over the laparoscopic approach. Nevertheless its oncological indications are yet to be defined.10


Distal Pancreatectomy Laparoscopic Distal Pancreatectomy Solid Pseudopapillary Tumor Tumor Cell Dissemination Pancreatic Gland 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Supplementary material

ESM1 (MPG 69226 kb)


  1. 1.
    Papavramidis T, Papavramidis S. Solid pseudopapillary tumors of the pancreas: review of 718 patients reported in English literature. J Am Coll Surg. 2005;200:965–72.PubMedCrossRefGoogle Scholar
  2. 2.
    Canzonieri V, Berretta M, Buonadonna A, Libra M, Vasquez E, Barbagallo E, et al. Solid pseudopapillary tumour of the pancreas. Lancet Oncol. 2003;4:255–6.PubMedCrossRefGoogle Scholar
  3. 3.
    Yu PF, Hu ZH, Wang XB, Guo JM, Cheng XD, Zhang YL, et al. Solid pseudopapillary tumor of the pancreas: a review of 553 cases in Chinese literature. World J Gastroenterol. 2010;16: 1209–14.PubMedCrossRefGoogle Scholar
  4. 4.
    Mortenson MM, Katz MH, Tamm EP, Bhutani MS, Wang H, Evans DB, et al. Current diagnosis and management of unusual pancreatic tumors. Am J Surg. 2008;196:100–13.PubMedCrossRefGoogle Scholar
  5. 5.
    Borja-Cacho D, Al-Refaie WB, Vickers SM, Tuttle TM, Jensen EH. Laparoscopic distal pancreatectomy. J Am Coll Surg. 2009;209:758–65.PubMedCrossRefGoogle Scholar
  6. 6.
    Khanna A, Koniaris LG, Nakeeb A, Schoeniger LO. Laparoscopic spleen-preserving distal pancreatectomy. J Gastrointest Surg. 2005;9:733–8.PubMedCrossRefGoogle Scholar
  7. 7.
    Vasilescu C, Sgarbura O, Tudor S, Herlea V, Popescu I. Robotic spleen-preserving distal pancreatectomy. A case report. Acta Chir Belg. 2009;109:396–9.PubMedGoogle Scholar
  8. 8.
    Giulianotti PC, Sbrana F, Bianco FM, Addeo P, Caravaglios G. Robot-assisted laparoscopic middle pancreatectomy. J Laparoendosc Adv Surg Tech A. 2010;20:135–9.PubMedCrossRefGoogle Scholar
  9. 9.
    Ntourakis D, Marzano E, Lopez Penza PA, Bachellier P, Jaeck D, Pessaux P. Robotic distal splenopancreatectomy: bridging the gap between pancreatic and minimal access surgery. J Gastrointest Surg. 2010;14:1326–30.PubMedCrossRefGoogle Scholar
  10. 10.
    Giulianotti PC, Sbrana F, Bianco FM, Elli EF, Shah G, Addeo P, et al. Robot-assisted laparoscopic pancreatic surgery: single-surgeon experience. Surg Endosc. 2010;24:1646–57.PubMedCrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2010

Authors and Affiliations

  • Dimitrios Ntourakis
    • 1
  • Ettore Marzano
    • 1
  • Vito De Blasi
    • 1
  • Elie Oussoultzoglou
    • 1
  • Daniel Jaeck
    • 1
  • Patrick Pessaux
    • 1
    Email author
  1. 1.Pôle des Pathologies Digestives, Hépatiques et de la Transplantation, Hôpital de Hautepierre—Hôpitaux Universitaires de StrasbourgUniversité de StrasbourgStrasbourgFrance

Personalised recommendations