Robotic central pancreatectomy in pediatric patients: a systematic review and technical innovation of externalized duct stent reconstruction

Robotic pancreatic surgery in children remains rarely reported. Central pancreatectomy (CP) offers a parenchyma-sparing option for benign or low-grade malignant tumors. Adult data suggest externalized duct stents may mitigate postoperative pancreatic fistula (POPF), but pediatric evidence is lacking. A systematic search of MEDLINE, Embase and the Cochrane Library (November 2025) identified reports of robotic pancreatic resection in pediatric patients. Data on pathology and perioperative outcomes were extracted. We additionally provide a technical description of a reproducible surgical approach applied in two consecutive pediatric patients undergoing robotic CP with Roux-en-Y duct-to-mucosa pancreaticojejunostomy (PJ) and externalized pancreatic duct stent at a high-volume pancreatic center. A detailed video documents the step-by-step technique. Perioperative and 6-month outcomes are reported. Ten case reports were included. Indications were solid pseudopapillary tumor (SPT) (n = 7), insulinoma (n = 2), and pancreatic neuroendocrine tumor (NET) (n = 1). Procedures comprised distal pancreatectomy (DP) (n = 5), pancreatoduodenectomy (PD) (n = 2), CP (n = 1), and enucleation (n = 2). PJ was used in all reconstructive procedures, and no study reported stent placement. POPF occurred in 1 patient after CP; other complications were infrequent. The described technique was applied in two pediatric: one developed biochemical leak (BL) and one grade B POPF, managed conservatively. At 6 months, pancreatic function was preserved with no recurrence. Robotic CP with PJ and externalized pancreatic duct stent is technically feasible in selected pediatric patients. However, given the limited evidence and lack of comparative data, no conclusions can be drawn regarding effectiveness. These findings are hypothesis-generating and require validation in multicenter studies.