Introduction: Robotic technology seems to widen the indications of minimally invasive surgery even for complex multiorgan surgery. This video demonstrates a totally robotic approach to diffuse and extensive extra nodal sinus histiocytosis (Rosai-Dorfman Disease) involving the distal pancreas, the hilar portion of the spleen, the colonic flexure and the left kidney.

Methods: The patient is a 35-year-old-female with a three year history of Rosai Dorman Syndrome (histiocytosis X).

Results: The procedure starts with the exploration of the abdominal cavity followed by the opening of the Lesser sac. The access to the retro cavity confirms the CT scan findings. The splenic artery is isolated and temporarily clipped. The splenic flexure of the colon is taken down and transected using an intestinal EndoGIA stapler. The pancreatic neck is also transected with a Vascular EdnoGIA stapler and the splenic vein and artery are ligated and divided. The dissection phase is completed by the isolation and transection of the renal artery and vein, followed by the section of the ovarian vein and of the left ureter. The pancreatic tail, spleen, left kidney and left colonic flexure are completely mobilized and an "en-bloc" resection is performed. The large specimen is retrieved trough a Pfannenstiel incision The operative time was 360 minutes, blood losses was 400ml. No intraoperative complications were observed. The patient was discharged on 5th post-operative day.

Conclusion: Our experience in robotic surgery allowed us to deal with more complex cases, offering the benefits of minimally invasive surgery to an increased number of patients.