Laparoscopic spleen-preserving distal pancreatectomy: description of an original posterior approach.

We are describing in this paper the original and innovative technique we used to perform a spleen-preserving distal pancreatectomy. With the patient positioned on her right lateral side, we inserted four laparoscopic ports in the left subcostal region to enable an upper view on the spleen and its rear attachments. With this approach, we opened and dissected this plan located between the left kidney and the rear aspect of the spleen and of the pancreas. These structures, once liberated naturally, felt "en-bloc" out of the way because of the patient's lateral positioning and the gravity, exposing the operative field without any artificial retraction. Beyond this greater exposure, this new approach offers many other advantages, such as the easiness to be performed by only two operators and the preservation of the anterior abdominal cavity, the great omentum, the splenic vessels, and the short gastric vessels left untouched.