Surgical Procedures

The laparoscopic spleen-preserving dissection of No. 10 lymph nodes via the retro-pancreatic approach is summarized as follows:
Surgical Steps:
Creation of Retro-pancreatic Space: Incise the inferior pancreatic border and develop the retro-pancreatic space anterior to the renal fascia, extending it toward the splenic lower pole, the splenomesenteric venous confluence, and the left diaphragmatic crus.
Right-sided Dissection:
Detach the greater omentum and transverse mesocolon to isolate and transect the right gastroepiploic vessels at their origin, dissecting No. 6 and No. 4sd LNs.
Incise the hepatoduodenal ligament to expose the proper hepatic artery and common bile duct. Isolate and transect the right gastric vessels, clearing No. 5 LNs.
Continue dissection along the proper hepatic artery (No. 12a LNs) and open the hepatogastric ligament to dissect No. 1 and No. 3 LNs.
Central Vascular Dissection:
After transecting the duodenum, elevate the stomach. Dissect the gastropancreatic fold to expose the left gastric vessels.
Isolate and transect the left gastric vessels at their origin, identifying the celiac trunk and its branches. Dissect No. 7, No. 9, and No. 8a LNs.
Left-sided and Splenic Hilar Dissection:
Incise the superior pancreatic border near the celiac trunk to access the retro-pancreatic space.
Circumferentially skeletonize the splenic artery and vein from proximal to distal, systematically dissecting No. 11p, No. 11d, No. 4sb, No. 4sa, and finally No. 10 LNs.
Isolate and transect the fundic branch of the left inferior phrenic artery to complete No. 2 LN dissection.