Indications and techniques for minimally invasive spleen-preserving distal pancreatectomy

Figure 1 Spleen-preserving distal pancreatectomy with en bloc removal of splenic vein and artery, and short gastric vessels preservation (Warshaw technique)[25]. SV: Splenic vein; SA: Splenic artery; SS: Short gastric. Created in BioRender (Supplementary material).

Figure 2 Spleen-preserving distal pancreatectomy with splenic vein and artery sparing, and short gastric vessels removal (Kimura technique)[26]. Created in BioRender (Supplementary material).

Figure 3 Spleen-preserving distal pancreatectomy with splenic vein and artery sparing using proximal control in case of bleeding. Created in BioRender (Supplementary material).

Figure 4 Example of upfront vessel control in lesions close to neck of the pancreas, using the splenic artery and splenic vein as route to dissection until the spleen, as also demonstrated in the Video 1. Created in BioRender (Supplementary material).

Figure 5 Example of upfront vessel control in lesions in tail of the pancreas, using the splenic artery and splenic vein as route to dissection until the spleen, especially for patients with previous Roux En Y gastric bypass as demonstrated in the Video 2. Created in BioRender (Supplementary material).

Figure 6 Robotic spleen preserving distal pancreatectomy. A: Hanging of the neck of the pancreas for proximal dissection of splenic vessels; B: Final aspect of proximal transection of the pancreas with vessel loops on splenic artery (red) and vein (blue). LGA: Left gastric artery; CHA: Common hepatic artery; SLP: Staple Line of the pancreas; SMC: Splenomesenteric confluence; SV: Splenic Vein; SA: Splenic artery. Created in BioRender (Supplementary material).