314 Robotic Splenic Vein-Preserving Distal Pancreatectomy: A Hybrid Technique for Spleen Preservation

Abstract This operative video demonstrates a novel modification of spleen-preserving distal pancreatectomy involving preservation of the splenic vein with division of the splenic artery. The case involves a 55-year-old woman with a large neuroendocrine tumour (NET) in the body of the pancreas. The technique aims to minimise the risk of left-sided portal hypertension while enabling adequate lymphadenectomy. The procedure was performed robotically using the Da Vinci Xi system. The video outlines pre-operative imaging, port placement, and intraoperative strategies including the use of ultrasound for vascular mapping and indocyanine green angiography to assess splenic perfusion and venous outflow. Post-operatively, the patient developed colonic pseudo-obstruction, managed conservatively. She was discharged on day nine. Histopathology confirmed a 45×50×59mm well-differentiated NET with 0/29 lymph nodes involved. At seven months, follow-up CT demonstrated a viable spleen and patent splenic vein. This video highlights a technically feasible alternative to traditional splenic preservation techniques in distal pancreatectomy that avoids the development of left-sided portal hypertension.