Laparoscopic total gastrectomy with spleen-preserving splenic hilar (No. 10) lymph nodes dissection

Laparoscopic total gastrectomy with spleen-preserving splenic hilar (No. 10) lymph nodes dissection is challenging due to the tortuous splenic vessels and possibility of parenchymal injury to the spleen or pancreas. Based on our anatomical understanding of peripancreatic structures, we combined the characteristics of laparoscopic surgery and developed a strategy using retro-pancreatic approach for laparoscopic spleen-preserving No. 10 lymph nodes dissection.