Background
Duodenal neuroendocrine neoplasm (d-NEN) are rare entities with very different clinical course and biological behavior. Usually asymptomatic, diagnosis often relies on upper GI endoscopy. Rarely neoplasm are functioning, unless in metastatic cases, with ZES and carcinoid syndrome being the most frequent clinical presentation. A careful diagnostic workup is mandatory to plan the best treatment (endoscopy with biopsy, cromogranina A, CT-contrast enhanced abdominal scan, PET-TC-somatostatin receptor scintigraphy).

Materials and Methods
The case we present is peculiar for the treatment option, using completely robotic technology, at our knowledge the first one presented in literature. A female, 78 years old patient presented to the emergency department with a massive gastrointestinal bleeding.

Result
Operative time was 185 min., blood loss negligible. Postoperative course was uneventful. An oral contrast x-ray, in PO day 5, showed a regular transit with no signs of leaks. Patient was discharged in 7th PO day. Histopathology report showed a 2,5 cm x 1,5 cm, KI 67 10% NET , with submucosal involvement and angioinvasion, 3 metastatic lymph nodes, classified as a NET G2, T2N1, stage IIIB. Surgical margins were clear.

Conclusion
This technique was used in only three cases in our experience as the indications for Billroth I technique are rare, laparoscopic-assisted technique is described in literature, but we consider robotic technology, when available very useful and more precise. Comparative studies are necessary to demonstrate robotic advantages.