Exploratory laparoscopy is performed first to exclude local or distant extension of the neoplasm.
The small bowel is removed from the operative field and the table rotated/inclined with the left side up and in reverse Trendelenberg to obtain the best exposure.
The lesser sac is exposed by opening the gastrocolic ligament widely inferior to the gastroepiploic arcade using an ultrasonic scalpel (Ultracision, United States Surgical Co., CT) or electrothermal bipolar vessel sealing device (LigaSure Lap, Tyco Healthcare, CO). The splenic flexure of the colon is mobilized inferiorly to expose the pancreatic tail; if further exposure is needed, the short gastric vessels are transected.
The retroperitoneum is incised along the inferior and superior border of the body/tail of pancreas; the mesenteric vessels are identified at the uncinate process, as well as the splenic artery at the superior border of the pancreas.
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