Laparoscopic Posterior Radical Antegrade Modular Pancreatosplenectomy for Distal Pancreatic Carcinoma

Using non-invasive forceps, lift and pull the stomach towards the cephalic side and with an ultrasonic harmonic scalpel, cut the gastrocolic and gastro splenic ligaments at the upper edge of the transverse colon. To separate the stomach and spleen, ligate and sever the left gastroepiploic vessels, short gastric vessels, posterior gastric vessels, and left subphrenic vessels near the gastric wall. Then enter the lesser or mental sac, and explore the condition of the pancreatic tumor.

Next, separate and expose the common hepatic artery, followed by the celiac trunk and the left gastric artery, and dissect the lymph nodes surrounding both these arteries. Incise the retroperitoneum from the pancreatic neck to the pancreatic tail at the lower margin of the pancreas, and remove the surrounding lymph nodes. Then continue to incise the anterior layer of the left gerota fascia to reveal the left renal vein.

Peel the anterior layer of gerota fascia from the surface of the left kidney along the left renal vein. To expose the superior mesenteric artery and abdominal aorta, lift the distal pancreas toward the cephalic side, and simultaneously dissect the surrounding lymph nodes. Separate the superior mesenteric vein at the lower margin of the pancreatic neck, followed by the retro pancreatic tunnel along the surface of the FMV and portal vein.

Using a linear stapling device, sever the pancreas at the neck. After dissecting and exposing the splenic vein, ligate and sever its root. Dissect the splenic artery to remove the surrounding lymph nodes and ligate and cut off the artery root.

After lifting the pancreas and the anterior layer of the gerota fascia, sever the left adrenal vessel and peel off the anterior layer of the gerota fascia and the left adrenal gland upwards. Cut off the posterior peritoneum from right to left above the pancreas, and clear the connective tissues between the abdominal aorta and the left kidney along the left cross of diaphragm. Then sever the gerota fascia tissues at the upper margin of the left adrenal gland.

Next, sever the ligaments and adhesions around the spleen to release it and excise a distal pancreas, the anterior layer of the gerota fascia, the left adrenal gland, and the spleen as a whole. To carefully examine the surgical field, irrigate the abdominal cavity with sterile distilled water, and place a drainage tube beside the incisal margin of the pancreas. Finally, extend the umbilical incision length to about five centimeters.

Cut the abdominal wall layer by layer and take out the specimen. The postoperative CT scan indicates successful tumor removal without significant recurrence or metastasis.