Contents lists available at ScienceDirect Surgical Oncology journal homepage: www.elsevier.com/locate/suronc Robotic pancreatoduodenectomy for a solid pseudopapillary tumor in a ten- year-old child Jeroen Hagendoorn a,∗ , Carolijn L.M.A. Nota a,b , Inne H.M. Borel Rinkes a , I. Quintus Molenaar a a Dept. of Surgery, UMC Utrecht Cancer Center, Utrecht, The Netherlands b Dept. of Surgery, City of Hope National Medical Center, Duarte, CA, USA ARTICLE INFO Keywords: Pediatric whipple resection Minimally invasive surgery Pancreatic resection Whipple resection ABSTRACT Background: Pancreatoduodenectomy (Whipple resection) in children is feasible though rarely indicated. In several pediatric malignancies of the pancreas, however, it may be the only curative strategy [1]. With the emergence of robotic pancreatoduodenectomy as at least a clinically equivalent alternative to open surgery [2], it remains to be determined whether the pediatric population may potentially benefit from this minimally in- vasive procedure. Here we present, for the first time, a video of setup and surgical technique of robotic pan- creatoduodenectomy in a child. Methods: A 10-year-old girl presented with complaints of fullness and abdominal pain in the upper quadrants. Investigations including a diffusion-weighted, pancreatic MR scan suggested the diagnosis of solid pseudopa- pillary tumor (Frantz's tumor). The patient was considered for robotic pancreatoduodenectomy. Results: After anesthesia, the patient was placed supine on a split-leg table. Trocar placement was adjusted to accommodate the child's length and body weight, according to pre-operatively calculated positions that would allow for maximum working space and minimize inadvertent collision between the robotic arms. The da Vinci Si surgical robot was positioned in-line towards the surgical target and all four robotic arms were docked, while two additional laparoscopic ports were placed for tableside assistance. After standard pancreatoduodenectomy, a conventional loop reconstruction was performed including an end-to-side pancreaticojejunostomy with duct-to- mucosa technique and stapled side-to-side gastrojejunostomy. We suggest that in this patient group, pylorus preserving pancreatoduodenectomy with end-to-side duodenojejunostomy may be a suitable alternative. Post- operative recovery was complicated by delayed gastric emptying but otherwise unremarkable. Hospital length of stay was 12 days. Final pathology demonstrated a solid pseudopapillary tumor with negative surgical margins. Conclusion: This case illustrates the feasibility of robotic pancreatoduodenectomy in children. Essential elements of this procedure are a well-running robotic pancreatic surgery program as well as careful preoperative port placement planning. Supplementary video related to this article can be found at https:// doi.org/10.1016/j.suronc.2018.07.013 Disclosures Declarations of interest: none. Authorship statement All authors have made substantial contributions to all of the fol- lowing: (1) the conception and design of the study, or acquisition of data, or analysis and interpretation of data, (2) drafting the article or revising it critically for important intellectual content, (3) final approval of the version to be submitted. Funding sources This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Contributors Yanghee Woo, MD: Dept. of Surgery, City of Hope National Medical Center, Duarte, CA, USA. Kees P. van de Ven, MD: Dept. of Surgery, Prinses Máxima Center for Pediatric Oncology, Utrecht, The Netherlands. https://doi.org/10.1016/j.suronc.2018.07.013 Received 25 March 2018; Received in revised form 3 July 2018; Accepted 21 July 2018 ∗ Corresponding author. Dept. of Surgery, UMC Utrecht Cancer Center, G04.2.28 Heidelberglaan 100, 3583 CX, Utrecht, The Netherlands. E-mail address: j.hagendoorn-3@umcutrecht.nl (J. Hagendoorn). Surgical Oncology 27 (2018) 635–636 0960-7404 T