1. Robotic spleen preserving distal pancreatectomy in pediatric patient. Case report Young Ju Hong M.D., Seonae Ryu, Hye Kyung Chang M.D., Jung Tak Oh M.D., Seok Joo Han M.D. Department of Pediatric Surgery Severance Children`s Hospital Department of Surgery Yonsei University College of Medicine

2. Yonsei University Health System Background Solid papillary neoplasm rare pancreatic neoplasm (1~3% of primary pancreatic tumors) >80% : female, 85% : less than 30 years old With surgical complete excision 5 YSR : 95 % Aggressive variants : represent malignant degeneration in an otherwise indolent tumor Surgical resection is indicated in all instances

3. Yonsei University Health System Background Minimally invasive surgery for pancreatic tumor 1996 first laparoscopic distal pancreatectomy Low grade tumor, young patient : choice Splenic preservation : useful, especially in children da Vinci robot system 3D magnified field of view Precise and multi-articulated handlike motions Hand-tremor filtering system Ergonomically designed operative space

4. Case – History of illness F/16 C.C : low abdominal pain (duration : 2 weeks) Laboratory test 4800(33%) 12.5/37.4 308K Amylase/lipase 74/25 CEA 0.91 CA 19-9 1.5 Yonsei University Health System

5. Case – MRI

7. Case – PET CT

8. Case – Operation

9. Case – Pathology Solid pseudopapillary tumor – size : 1x0.8cm – Mitosis : 3/10 HPF – LVI : not identified – Resection margin : free from tumor IH stain – Vimentin and beta- catenin : positive – CD 10 : focally and weakly positive – Chromogranin A : Negative

10. Case – Progress POD 2 : gas out(+), SOW POD 4 : soft diet POD 5 : Lab : WNL, CT POD 8 : discharge

11. Robotic spleen preserving distal pancreatectomy in pediatric patient Safe Feasible treatment option that preserves splenic function for benign or low grade malignant tumor of the distal pancreas Yonsei University Health System Conclusion

12. Thank you for your attention