Figure 4.

(A) Radical antegrade modular pancreatosplenectomy (RAMPS) proceeds in a right-to-left antegrade manner, with early parenchymal transection at the neck of the pancreas, close to the gastroduodenal artery (blue arrow) and early control of the splenic vessels (in its origin) (white arrow). The black arrow marks the common hepatic artery, and the asterisk shows a partial venous excision spleno–mesenteric confluence with direct closure (venorrhaphy). (B) Posterior RAMPS. The posterior magnitude of dissection was behind the left adrenal gland, including the Gerota fascia and the fat tissue around the left kidney. The left renal artery is shown with white arrow. Blue arrow shows the pancreas stump. Black arrow, superior mesenteric vein.