Robotic Central Pancreatectomy

Preston Palm, MS, IV

Product Details
Product ID: ACS-6155
Year Produced: 2020
Length: 9 min.


Pancreatic neuroendocrine tumors (PNETs) comprise 1-2% of all pancreatic neoplasms. The incidence of PNETs is estimated to be 1/100,000 per year in the United States. This figure continues to rise as imaging technologies become more sophisticated and the threshold for imaging decreases. There is little consensus regarding the optimal management of small, non-functional, primary, non-metastatic PNETs. Surgical management of these patients remains highly individualized. A 49-year-old male with diabetes mellitus type II presented with an incidentally discovered 12 mm. lesion located in the pancreatic neck. Further workup revealed a well-differentiated (Grade 1) neuroendocrine tumor. Given the location of the lesion, the patient's comorbidities, and the desire to retain pancreatic function, the patient agreed to robotic central pancreatectomy. The pancreas was transected 1 cm. distal to the lesion with monopolar curved scissors. It was again transected 1 cm. proximal to the lesion with an endoscopic stapler. After removal of the mass-containing segment, the distal main pancreatic duct was cannulated with a 5 fr. pediatric feeding tube, and a dunking gastropancreatic anastomosis was created high on the posterior gastric wall. There were no significant complications. The patient was discharged on post-operative day seven, and final surgical pathology reported a 2 cm., well-differentiated (Grade 2) neuroendocrine tumor without evidence of nodal metastasis. Central pancreatectomy spares pancreatic parenchyma and function in patients with small, non-functional, primary, non-metastatic PNETs located at the pancreatic neck. The technique described may also yield a more secure enteropancreatic anastomosis over traditional approaches.