Fig. 4

Intraoperative image in the final stage. A The origin of the splenic artery (i) is isolated and ligated in the suprapancreatic lesion without its division. Therefore, entire arterial blood supply to the specimen is interrupted. B The origin of the splenic vein (j), which is a main draining vessel, is isolated and divided. The splenic artery is then divided at its origin. C The pancreatic tail and the spleen are dissected off the left kidney (k) in a right-to-left fashion. D The artery-first laparoscopic radical antegrade modular pancreatosplenectomy (L-RAMPS) using a 3D technique is completed