• Bondoc Irina "Prof. Dr. Alexandru Trestioreanu" Institute of Oncology Bucharest, Romania
  • Marius Zamfir "Prof. Dr. Alexandru Trestioreanu" Institute of Oncology Bucharest, Romania & "Carol Davila" University of Medicine and Pharmacy Bucharest, Romania
  • Andrei Văcărașu "Prof. Dr. Alexandru Trestioreanu" Institute of Oncology Bucharest, Romania
  • Bogdan Cosmin Tănase "Prof. Dr. Alexandru Trestioreanu" Institute of Oncology Bucharest, Romania
  • Mara Mardare "Prof. Dr. Alexandru Trestioreanu" Institute of Oncology Bucharest, Romania & "Carol Davila" University of Medicine and Pharmacy Bucharest, Romania
  • Dana Cernov "Prof. Dr. Alexandru Trestioreanu" Institute of Oncology Bucharest, Romania
  • Claudiu Ungureanu "Sfântul Ioan" Clinical Emergency Hospital Bucharest, Romania
  • Dan Nicolae Păduraru General Surgery Department, University Emergency Hospital of Bucharest, Romania & “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
  • Octav Ginghină "Prof. Dr. Alexandru Trestioreanu" Institute of Oncology Bucharest, Romania & "Carol Davila" University of Medicine and Pharmacy Bucharest, Romania
Keywords: robotic surgery, distal pancreatectomy, complication, cystic pancreatic neoplasm


Pancreatic resections are complex surgical procedures that can be marked by complications during operative or postoperative time. In order to prevent some of the complications different approaches have been used including minimal invasive approach (MIP).  In the past decade robot assisted pancreatic surgery gained progress with regard to less surgical trauma, rapid recovery, less estimated blood loss, less wound infection and less incisional hernia with similar oncologic outcomes and survival rate to open approach. However, robotic pancreatic surgery is not free of complications like postoperative pancreatic fistula or fluid collection. We present the case of a 27-year-old female patient diagnosed with voluminous pancreatic cyst where robot assisted distal pancreatectomy with intention of spleen preserving was performed.


[1] J. Kleeff et al., “Distal Pancreatectomy,” Annals of Surgery, vol. 245, no. 4, pp. 573–582, Apr. 2007, doi: 10.1097/01.sla.0000251438.43135.fb.
[2] J. Winter et al., “1423 Pancreaticoduodenectomies for Pancreatic Cancer: A Single-Institution Experience☆,” Journal of Gastrointestinal Surgery, vol. 10, no. 9, pp. 1199–1211, Nov. 2006, doi: 10.1016/j.gassur.2006.08.018.
[3] T. de Rooij et al., “Minimally Invasive Versus Open Distal Pancreatectomy (LEOPARD),” Annals of Surgery, vol. 269, no. 1, pp. 2–9, Jan. 2019, doi: 10.1097/sla.0000000000002979.
[4] C. Ricci et al., “Laparoscopic versus open distal pancreatectomy for ductal adenocarcinoma: a systematic review and meta-analysis,” Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract, vol. 19, no. 4, pp. 770–781, Apr. 2015, doi: 10.1007/s11605-014-2721-z.
[5] D. Magge et al., “Comparative effectiveness of minimally invasive and open distal pancreatectomy for ductal adenocarcinoma,” JAMA surgery, vol. 148, no. 6, pp. 525–531, Jun. 2013, doi: 10.1001/jamasurg.2013.1673.
[6] J. A. Stauffer, A. Rosales-Velderrain, R. F. Goldberg, S. P. Bowers, and H. J. Asbun, “Comparison of open with laparoscopic distal pancreatectomy: a single institution’s transition over a 7-year period,” HPB: the official journal of the International Hepato Pancreato Biliary Association, vol. 15, no. 2, pp. 149–155, Feb. 2013, doi: 10.1111/j.1477-2574.2012.00603.x.
[7] W. Zhao, C. Liu, S. Li, D. Geng, Y. Feng, and M. Sun, “Safety and efficacy for robot-assisted versus open pancreaticoduodenectomy and distal pancreatectomy: A systematic review and meta-analysis,” Surgical Oncology, vol. 27, no. 3, pp. 468–478, Sep. 2018, doi: 10.1016/j.suronc.2018.06.001.
[8] T. Hackert, J. Werner, and M. W. Büchler, “Postoperative pancreatic fistula,” The Surgeon: Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland, vol. 9, no. 4, pp. 211–217, Aug. 2011, doi: 10.1016/j.surge.2010.10.011.
[9] A. S. Mendoza, H.-S. Han, S. Ahn, Y.-S. Yoon, J. Y. Cho, and Y. Choi, “Predictive factors associated with postoperative pancreatic fistula after laparoscopic distal pancreatectomy: a 10-year single-institution experience,” Surgical Endoscopy, vol. 30, no. 2, pp. 649–656, Jun. 2015, doi: 10.1007/s00464-015-4255-1.
[10] M. Sugimoto et al., “Risk factor analysis and prevention of postoperative pancreatic fistula after distal pancreatectomy with stapler use,” Journal of Hepato-Biliary-Pancreatic Sciences, vol. 20, no. 5, pp. 538–544, Jun. 2013, doi: 10.1007/s00534-013-0596-0.
[11] P. D. Sinwar, “Overwhelming post splenectomy infection syndrome – Review study,” International Journal of Surgery, vol. 12, no. 12, pp. 1314–1316, Dec. 2014, doi: 10.1016/j.ijsu.2014.11.005.
[12] H. Kim et al., “A single-center experience with the laparoscopic Warshaw technique in 122 consecutive patients,” Surgical Endoscopy, vol. 30, no. 9, pp. 4057–4064, Sep. 2016, doi: 10.1007/s00464-015-4720-x.
[13] W. Kimura et al., “Spleen-preserving distal pancreatectomy with conservation of the splenic artery and vein: techniques and its significance,” Journal of Hepato-Biliary-Pancreatic Sciences, vol. 17, no. 6, pp. 813–823, Dec. 2009, doi: 10.1007/s00534-009-0250-z.
[14] A. L. Warshaw, “Distal pancreatectomy with preservation of the spleen,” Journal of Hepato-Biliary-Pancreatic Sciences, vol. 17, no. 6, pp. 808–812, Oct. 2009, doi: 10.1007/s00534-009-0226-z.
[15] S. Chen et al., “Robotic approach improves spleen-preserving rate and shortens postoperative hospital stay of laparoscopic distal pancreatectomy: a matched cohort study,” Surgical Endoscopy, vol. 29, no. 12, pp. 3507–3518, Mar. 2015, doi: 10.1007/s00464-015-4101-5.
[16] S.-B. Xu, C.-K. Jia, J.-R. Wang, R.-C. Zhang, and Y.-P. Mou, “Do patients benefit more from robot assisted approach than conventional laparoscopic distal pancreatectomy? A meta-analysis of perioperative and economic outcomes,” Journal of the Formosan Medical Association = Taiwan Yi Zhi, vol. 118, no. 1 Pt 2, pp. 268–278, Jan. 2019, doi: 10.1016/j.jfma.2018.05.003.
[17] E. C. H. Lai and C. N. Tang, “Robotic distal pancreatectomy versus conventional laparoscopic distal pancreatectomy: a comparative study for short-term outcomes,” Frontiers of Medicine, vol. 9, no. 3, pp. 356–360, Aug. 2015, doi: 10.1007/s11684-015-0404-0.
[18] S. Lof et al., “Robotic versus laparoscopic distal pancreatectomy: multicentre analysis,” The British Journal of Surgery, vol. 108, no. 2, pp. 188–195, Mar. 2021, doi: 10.1093/bjs/znaa039.
[19] Y. Hu et al., “Meta-analysis of short-term outcomes comparing robot-assisted and laparoscopic distal pancreatectomy,” Journal of Comparative Effectiveness Research, vol. 9, no. 3, pp. 201–218, Feb. 2020, doi: 10.2217/cer-2019-0124.
[20] C. Tjaden et al., “Fluid collection after distal pancreatectomy: a frequent finding,” HPB, vol. 18, no. 1, pp. 35–40, Jan. 2016, doi: 10.1016/j.hpb.2015.10.006.
[21] Sierzega M, Kulig P, Kolodziejczyk P, Kulig J. Natural history of intra-abdominal fluid collections following pancreatic surgery. J Gastrointest Surg. 2013 Aug;17(8):1406-13. doi: 10.1007/s11605-013-2234-1. Epub 2013 May 29. PMID: 23715649; PMCID: PMC3709084.
[22] K. B. Song et al., “The treatment indication and optimal management of fluid collection after laparoscopic distal pancreatectomy,” Surgical Endoscopy, vol. 33, no. 10, pp. 3314–3324, Dec. 2018, doi: 10.1007/s00464-018-06621-w.
[23] B. A. Boone et al., “Assessment of Quality Outcomes for Robotic Pancreaticoduodenectomy,” JAMA Surgery, vol. 150, no. 5, p. 416, May 2015, doi: 10.1001/jamasurg.2015.17.
[24] N. Napoli et al., “The Learning Curve in Robotic Pancreaticoduodenectomy,” Digestive Surgery, vol. 33, no. 4, pp. 299–307, May 2016, doi: 10.1159/000445015.