Fig. 1

The technique of standard en bloc spleen-preserving LDP. a Dissect the gastro-colic ligament and disconnect the transverse mesocolon from the Gerota fascia. b At the level above the upper surface of the pancreas, isolate the left gastro-epiploic vein (LGEV) and the communicating veins from the distal pancreas. Preserve the LGEV. c Dissect between the communicating vessels and the distal pancreas. d At the tail of the pancreas, dissect the Gerota fascia from the lower border of the left renal vein upward to the left kidney. e Continue to dissect the Gerota fascia to the left border of the superior mesentery artery (SMA). Dissect the lymph nodes and celiac ganglion group II around the SMA preserving the 5-mm ganglion at the right side. f Continue to dissect upward to the splenic vein. Expose the splenic vein and IMV and ligate and cut off the IMV. g Penetrate the pancreas from the posterior surface at the root of the splenic vessels. h Dissect the pancreas at the root of the splenic vessels with a Harmonic scalpel. i Isolate the splenic vein at the root and dissect it. j Isolate the splenic artery at the root and dissect it. k Dissect the lymph nodes and celiac ganglion group I around the celiac trunk preserving the 5-mm ganglion at the right side. l Dissect the retroperitoneum adipose tissue at the upper border of the pancreas. Expose the left adrenal vessels and adrenal gland. m Preserve the adrenal gland if it has not been invaded. Dissect the retroperitoneum adipose tissue to the origin. n Ligate and dissect the spleen vessels at the tail of the pancreas. o Invertedly suture the stump of the pancreas. p Leave a drainage tube in the surgical site