Robotic spleen-preserving distal pancreatectomy with splenic vessels resections for portal annular pancreas: A pincer maneuver technique (with Video)

Background As portal annular pancreas (PAP) is a rare pancreatic anomaly, few studies have reported surgical techniques of robotic distal pancreatectomy for patients with PAP [1, 2]. This study presents our novel approach, namely a pincer maneuver technique, during robotic spleen-preserving distal pancreatectomy (R-SPDP) with splenic vessels resections for PAP. Methods A 56-year-old woman with intraductal papillary mucinous neoplasm, accompanied by recurrent pancreatitis, underwent R-SPDP. Preoperative computed tomography images detected a 2.5-cm tumor with surrounding inflammation and PAP. Results Initially, the ventral pancreas was dissected and transected on the superior mesenteric vein using a stapler. Following the division of the splenic vessels (the Warshaw technique), the splenic hilum was encircled and transected. The pancreatic body was mobilized in a lateral-to-medial fashion using the lateral approach. Finally, the dorsal part of the PAP was encircled and stapled using a pincer maneuver technique (Fig. 1), and the specimen was resected. The operative time was 161min, and the estimated blood loss was 20mL. The patient did not develop a postoperative pancreatic fistula. Conclusions To the best of our knowledge, this study is the first to describe surgical techniques of R-SPDP in the presence of PAP using a pincer maneuver technique. Using this technique, the dorsal part of the PAP was safely encircled and divided at the final step of specimen removal. Our novel pincer maneuver technique may be a useful and optional approach during R-SPDP with splenic vessels resections for PAP.