Editing Distal pancreatectomy (section)

== Technique for distal pancreatectomy and splenectomy ==

* Transverse subcostal incision
* Expose pancreas by separating omentum from transverse mesocolon and entering lesser sac
* Fixed retraction
* Identify SMV, first by following middle colic vein down to it from above from within the transverse mesocolon. 
* Gently develop the plane between the vein and pancreas using blunt dissection. Get your finger in behind the pancreas, then cut down onto your fingertip from above to complete the separation.
* Divide pancreas
** Transection with either stapler or diathermy then oversewing show equivalent rates of fistula
** GIA blue, although can adapt to bulkiness of pancreas
** Need to underrun the duct with 4/0 PDS if using diathermy
* Ligate splenic artery with suture transfixion x2
* Ligate vein, if possible just distal to IMV entry to preserve it
* Continue medial to lateral dissection posterior to pancreas and anterior to left renal vein, and then dividing splenic ligaments to remove specimen
* Haemostasis, two drains in pancreatic bed