STEP 2Entering the lesser sac

The gastrocolic omentum is divided using an ultrasonic dissector (harmonic scalpel), allowing access to the lesser sac behind the stomach.

The stomach is retracted rostrally by the assistant, and the lesser sac and anterior surface of the pancreas are explored laparoscopically.

The lesion in the tail of pancreas may then become obvious.

Should the lesion not be obvious, laparoscopic ultrasonography can help localize the site of the lesion.

Laparoscopic ultrasonography should also be used to explore the liver if the possibility of metastasis from the malignant tumor exists.

The posterior peritoneum along the inferior surface of the pancreas is incised toward the spleen.

The pancreas is mobilized gently by lifting it off the posterior, retroperitoneal soft tissues, and the feasibility of laparoscopic resection is confirmed.

Retracted Liver Lesser Omentum

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