Laparoscopic splenic hilum lymph node dissection for advanced proximal gastric cancer: A modified approach for pancreas- and spleen-preserving total gastrectomy

Core Tip

Core tip: Pancreas- and spleen-preserving splenic hilum lymph node dissection in laparoscopic total gastrectomy is challenging. Even though a small number of skilled laparoscopic surgeons have demonstrated the safety and feasibility of this procedure, most surgeons adopt only the suprapancreatic approach. However, exposure and dissection of splenic hilum lymph nodes posterior to the splenic artery, especially its inferior branch is sometimes difficult and unpredicted injury or bleeding is more likely to occur if only through the suprapancreatic approach. We combined the supra- and infra-pancreatic approaches to better expose the posterior splenic artery lymph nodes at the splenic hilum and dissect more safely.