STEP 1Positioning and access

The patient is positioned with slight left side elevation and the table broken 15° to 20° at the costal margin. This positioning improves access to the retropancreatic space for dissection of the splenic vein.

The incision is a bilateral subcostal incision, primarily on the left side and extended well laterally. Retraction requires a fixed retractor system elevating the left costal margin. Other blades of the retractor are used to aid exposure as indicated below. Figures A-1 and A-2 illustrates the incision and the area of dissection for DSRS.

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