Aims: Multi-quadrant complex minimally invasive surgery is extremely facilitated by the new da Vinci® Xi surgical system. We present a case of a robotic Appleby pancreatectomy using this platform and the robotic staplers.

Methods: A 73-years old woman with a CT scan finding of a 30-mm hypo-vascular neoplasm of the pancreas body underwent surgery with the use of the new da Vinci® Xi platform with four arms and upper quadrants trocars' disposition.

Results: The procedure was successfully completed in 285 min. The pancreatic body was mobilized to expose the portal-mesenteric axis. The gland was transected using a robotic endo-stapler as well as the splenic vein. After evaluating the patency of collateral circles with intraoperative ultrasound, the common hepatic and the celiac arteries were transected. The neoplasm was then detached from the gastric body with a tangential gastric resection with the use of the robotic endo-stapler. Finally, the posterior attachment of the spleen and the pancreatic tail were transected. No conversion of surgical technique or intra-operative complications occurred. The post-operative course was uneventful and the patient was discharged 6 days after surgery.

Conclusions: The da Vinci® Xi system with its specific tools allows to perform challenging procedures such as Appleby pancreatectomy for locally advanced cancer. The robotic endo-Wrist stapler permits the operating surgeon to directly control the transaction phase.