García-Picazo Alberto, Sánchez-Velázquez Patricia, Burdío Fernando, Vellalta Gemma, Ielpo Benedetto
Hepato‑Biliary and Pancreatic Surgery Unit, Department of Surgery, Hospital del Mar, Pompeu Fabra University, Barcelona, Spain.
Ann Surg Oncol. 2025 Sep 9. doi: 10.1245/s10434-025-18294-6.
Spleen-preserving distal pancreatectomy by robotic surgery is a safe and feasible surgical technique. Currently, spleen-preserving distal pancreatectomy represents an alternative to the classical distal pancreatectomy with splenectomy, in the case of benign and low-grade malignant diseases of the body or pancreas tail. The reasons for preserving the spleen are based on the reduction of postoperative complications, such as post-splenectomy infections, subphrenic abscess, portal thrombosis, pulmonary hypertension, thrombocytosis, and thromboembolism. This procedure can be performed by completely preserving the splenic vessels (Kimura technique), not preserving the splenic vessels (Warshaw technique), or just resecting the splenic vein (Kim technique).
The robotic approach is a feasible option for this surgery, in terms of reducing postoperative pain and facilitating patient recovery without increasing the risk of pancreatic fistula, hospital readmission, morbidity, and mortality. Compared with laparoscopy, robotic surgery demonstrates a lower conversion rate and reduced splenectomy rate. This surgical technique can be technically demanding, even robotically, therefore several maneuvers are described to reduce operative difficulty and improve surgical outcomes.
The objective of this video is to provide a step-by-step guide to robotic spleen-preserving distal pancreatectomy surgery, highlighting tips and innovations for improved safety and effectiveness.
机器人手术行保留脾脏的胰体尾切除术是一种安全可行的手术技术。目前，对于胰体或胰尾的良性及低级别恶性疾病，保留脾脏的胰体尾切除术是经典的胰体尾切除加脾切除术的一种替代方案。保留脾脏的原因在于减少术后并发症，如脾切除术后感染、膈下脓肿、门静脉血栓形成、肺动脉高压、血小板增多症以及血栓栓塞。该手术可通过完全保留脾血管（木村技术）、不保留脾血管（华沙技术）或仅切除脾静脉（金氏技术）来完成。
就减轻术后疼痛并促进患者恢复而言，机器人手术是该手术的一种可行选择，且不会增加胰瘘、再次入院、发病率及死亡率的风险。与腹腔镜手术相比，机器人手术的中转率更低，脾切除率也更低。即便采用机器人手术，该手术技术在操作上也可能具有挑战性，因此介绍了几种操作方法以降低手术难度并改善手术效果。
本视频的目的是提供一份机器人保留脾脏的胰体尾切除术的分步指南，重点介绍提高安全性和有效性的技巧与创新方法。
