Surgery for Pancreatic Cysts

Surgeons at NYU Langone are experts at removing pancreatic cysts. We specialize in advanced, minimally invasive techniques and perform many of our pancreatic cyst procedures with robotic-assisted surgery. This method offers enhanced precision, smaller incisions, reduced blood loss, and faster recovery compared to conventional, open surgery.

Depending on your diagnosis and the size and location of the pancreatic cyst, we may recommend pancreatic enucleation, the Whipple procedure, distal pancreatectomy, spleen-preserving distal pancreatectomy, or a pancreatic cyst gastrostomy.

Pancreatic Enucleation

For pancreatic cysts that are small, low-risk, and located away from the main pancreatic duct, our surgeons may recommend pancreatic enucleation. This minimally invasive procedure removes only the cyst while preserving as much healthy pancreatic tissue as possible.

Doctors typically perform this surgery using a laparoscope—a thin, lighted tube inserted through small abdominal incisions that allows the surgeon to see inside and operate with precision—or with robotic surgery for even greater control and accuracy.

Whipple Procedure

The Whipple procedure involves removing the head of the pancreas along with the first part of the small intestine, also known as the duodenum; part of the bile duct; the gallbladder; and sometimes part of the stomach.

We may recommend the procedure, often performed with robotic surgery, for intraductal papillary mucinous neoplasms in the head of the pancreas with high-risk features such as large size, mural nodules, or symptoms. These cysts may involve the main pancreatic duct or be mixed type, meaning they affect both the main duct and the smaller branch ducts that connect to it.

The procedure may also be an option to treat larger or symptomatic cystic neuroendocrine tumors in the head of the pancreas or large serous cystic neoplasms that cause significant symptoms.

Distal Pancreatectomy

A distal pancreatectomy involves the removal of the body and tail of the pancreas, often along with the spleen. Our surgeons may recommend this procedure for intraductal papillary mucinous neoplasms, mucinous cystic neoplasms, or cystic neuroendocrine tumors in the body or tail of the pancreas. We typically perform the procedure using robotic-assisted surgery.

Spleen-Preserving Distal Pancreatectomy

For intraductal papillary mucinous neoplasms, mucinous cystic neoplasms, or cystic neuroendocrine tumors in the body or tail of the pancreas, our surgeons may recommend a spleen-preserving distal pancreatectomy. This technique removes the affected portion of the pancreas while preserving the spleen, which helps maintain immune function. This reduces the risk of postsurgical infections, especially in younger or otherwise healthy patients.

Pancreatic Cyst Gastrostomy

Pancreatic cyst gastrostomy is a drainage procedure that our doctors may use if a pancreatic pseudocyst develops and causes symptoms such as pain, the sensation of a full stomach, or vomiting. These cysts may occur as a complication of acute pancreatitis if inflammation and swelling cause the ducts to become damaged.

Some pseudocysts go away on their own, but many require treatment to avoid more serious complications, such as infection or an abscess. In severe circumstances, a pseudocyst may become necrotic, meaning it contains dead tissue.

NYU Langone doctors usually drain a pancreatic pseudocyst using a minimally invasive endoscopic or robot-assisted laparoscopic approach. If necessary, our surgeons or gastroenterologists may also remove any dead tissue, a procedure called a necrosectomy.

After Surgery

Here is what patients undergoing major surgeries such as the Whipple procedure or distal pancreatectomy may expect:

• a hospital stay of several days to a week or more, with the support of nurses, pain management specialists, and physical therapists to ensure comfort and steady healing
• detailed instructions after discharge on wound care, pain management, dietary changes, and activity limitations
• a gradual return to normal activities over weeks to months
• recommendations from our dietitians on necessary dietary adjustments, including managing digestive enzymes.

This is what patients can expect for less invasive procedures such as pancreatic enucleation or pancreatic cyst gastrostomy:

• an overnight hospital stay or even outpatient care, with a relatively quick recovery
• follow-up care focused on monitoring cyst drainage and managing symptoms
• guidance from our care team on activity and diet as well as follow-up imaging to ensure proper tissue healing or cyst drainage