Distal Pancreatectomy with Spleen Preservation

We present the case of a 38-year-old female patient with past medical history of cholecystectomy, who presented chronic pancreatitis secondary to distal obstructive pancreatolithiasis. It was presented in a multidisciplinary tumor board, deciding she was tributary to surgical treatment. It was proposed for a robotic distal pancreatectomy with splenic preservation. Preoperative magnetic resonance cholangiography revealed a dilated Wirsung’s duct secondary to obstructive pancreatolithiasis. At surgery, a clear color change of the pancreatic gland was observed, at the site were the pancreatolithiasis was present. An intraoperative ultrasound was performed visualizing the pancreatolithiasis, with Wirsung's duct dilatation distal to it. An intravenous dose of indocyanine green was administered to confirm correct vascularization of the pancreas. Distal pancreatectomy was performed, identifying and preserving the splenic artery and vein. The neck of the pancreas was sectioned using a reinforced endostapler, with a slow compression and posterior section. A drain was placed at the surgical site. The postoperative course was uneventful, and she was discharged from the hospital on the fourth postoperative day without abdominal drainage. Pathology confirms a 1.6cm pancreatolithiasis, signs of chronic pancreatitis and no evidence of malignancy.