Supplementary Material for: Robotic Spleen-Preserving Distal Pancreatectomy with Preservation of Splenic Vessels Using the Gastrohepatic Ligament Approach: The Superior Window Approach in the Kimura Technique

Minimally invasive spleen-preserving distal pancreatectomy (SPDP) is technically challenging, and only a few reports have described surgical approaches for minimally invasive SPDP. This report demonstrates our novel gastrohepatic ligament approach in robotic SPDP with preservation of the splenic vessels (the superior window approach in the Kimura technique). Our gastrohepatic ligament approach for robotic SPDP included four steps. First, the gastrohepatic ligament was divided extensively, and the pancreas was confirmed (step 1). In this step, we did not lift the stomach, nor did we divide the gastrocolic ligament. Next, the superior and inferior borders of the pancreas were dissected, and tunneling of the pancreas on the superior mesenteric vein was performed (step 2). Following the division of the pancreas (step 3), the pancreatic body and tail were dissected from the medial to the lateral side with preservation of the splenic vessels (step 4). Using this approach, the pancreas can be directly accessed via the gastrohepatic ligament route and dissected without division of the gastrocolic ligament or retraction of the stomach. The present approach for robotic SPDP preserves splenic vessels, facilitating easy access to the pancreas with minimal dissection, and may be optional in selected patients, including those with low body mass index.

微创保留脾脏远端胰腺切除术（SPDP）具有较高技术挑战性，目前仅有少数文献报道了微创SPDP的手术入路方案。本研究介绍了我们团队在保留脾血管（splenic vessels）的机器人辅助SPDP中应用的新型肝胃韧带（gastrohepatic ligament）入路（即Kimura技术中的上方窗入路）。我们的机器人辅助SPDP肝胃韧带入路共分为四个步骤：第一步，广泛离断肝胃韧带并确认胰腺组织；此步骤中无需牵拉胃部，亦不离断胃结肠韧带（gastrocolic ligament）。第二步，游离胰腺的上下缘，并于肠系膜上静脉（superior mesenteric vein）前方完成胰腺隧道化分离。第三步，离断胰腺。第四步，在保留脾血管的前提下，从内侧向外侧游离胰体尾部。采用该入路，可经肝胃韧带直接探查胰腺，无需离断胃结肠韧带或牵拉胃部即可完成胰腺游离。本机器人辅助SPDP入路可保留脾血管，仅需少量游离即可便捷获取术野、探查胰腺，可作为低体重指数等特定患者的可选手术方案。