Background : Radical antegrade modular pancreatosplenectomy(RAMPS) was described to achieve negative tangential margins and increase in lymph node yield for resections of cancer in body and tail of pancreas. Robotic RAMPS in a patient with pancreatic tail adenocarcinoma is presented.

Methods : A 66- year-old lady with past medial history of hypertension and hyperlipidemia was followed up for dilated main pancreatic duct. Her surveillance MRI cholangio-pancreatiocograph (MRCP) revealed progressive dilatation of downstream pancreatic duct in the tail with suspicion of hypo-enhancing area. Endoscopic ultrasound was performed and detected a pancreatic tail hypoechoic mass. Biopsy performed and histology returned as adenocarcinoma. Staging scan showed no distant metastasis.

Results : Robotic RAMPS was performed successfully. Intra-operative findings revealed a soft pancreas and body of pancreas mass 2cm near neck of pancreas. No liver/ peritoneal metastasis seen during diagnostic laparoscopy. Diet was started on post-operative day 2 and she was discharged on post op day 5. Histology returned as 3.9cm pT2N0(0/45) LVI/PNI positive, moderately differentiated pancreatic ductal adenocarcinoma with clear margins. 45 lymph nodes were harvested.

Conclusions : Robotic RAMPS is a feasible and safe procedure that can achieve negative tangential margins and high lymph nodes yield in patients with distal pancreatic tumour.