How to do it: specimen splitting and lifting maneuver in robotic radical distal pancreatosplenectomy for borderline pancreatic body tumors

Robotic radical pancreatosplenectomy is an advanced minimally invasive procedure for left-sided pancreatic cancer, especially for borderline tumors with suspected vascular involvement. Building on the oncologic principles of Radical Antegrade Modular Pancreatosplenectomy (RAMPS), we describe technical refinements tailored to the robotic setting. Specifically, our approach begins with early pancreatic transection to facilitate vascular exposure of bulky tumors, unlike with the classical RAMPS sequence, while preserving key principles such as posterior dissection and extended lymphadenectomy. Two cases are presented: one that required venous divestment and one that involved reconstruction of the splenomesenteric confluence using a bovine pericardial patch. The specimen-splitting and lifting maneuver enhances vascular control and visualization, enabling safer dissection and resection. Both procedures were completed robotically without conversion, achieving R0 margins, followed by uneventful recovery. While this technique diverges from Strasberg’s original description, it aligns with its oncologic intent and reflects evolving surgical adaptations. Prospective data collection is ongoing to assess the long-term outcomes of complex cases.