Fig. 2

The outline of the artery-first approach using a dome-shaped dorsomedial dissection (3D) technique. A While both the pancreatic tail and spleen are kept attached in the subphrenic position, only the middle segment of the pancreas (a) is cranially mobilized toward the esophageal hiatus, resulting in obtaining a dome-shaped space behind the pancreatic body. B The left renal vein (b) is exposed to determine the dorsal dissection plane. The left adrenal vein (c) is simultaneously identified. C In the event of tumor infiltration to the anterior renal fascia, the left adrenal gland (d) is also excised with the pancreatic body. D The anterior surface of the superior mesenteric artery (SMA) (e), which can be identified below the pancreatic body, is cranially exposed. An arterial branching (f) to the pancreas from the SMA, known as the dorsal pancreatic artery, is divided