Fig. 3

Surgical findings. a The location of the tumor identified by intraoperative ultrasound is marked on the surface of the mobilized pancreas. The white double-arrowed line indicates the transection line of the distal pancreas. b After the first pancreatic transection at the distal side, the aberrant parenchyma of the portal annular pancreas between the uncinate process and body (white asterisk) is confirmed cranial to the confluence of the portal vein and splenic vein. Of note, the single-cut margin containing the main pancreatic duct (white arrowhead) is created at the distal pancreas. c, d Intraoperative ultrasound clearly shows the pancreatic tumor (white arrowhead) giving the information of the second transection line at the pancreatic head (white star). The main pancreatic duct, which is negative for a color Doppler signal, is also clearly seen (white arrowhead in c). e After the second pancreatic transection, the tumor is removed. f The surgical specimen. White bar is 1 cm. CHA: common hepatic artery, GDA: gastroduodenal artery, PV: portal vein, SMV: superior mesenteric vein, SPV: splenic vein, T: tumor