title: The Posterior Approach for Laparoscopic Distal Pancreatectomy: A Valid Choice for Resection of Complex Lesions of the Distal Pancreas.
abstract: BACKGROUND
  Laparoscopic distal pancreatectomy (LDP) is replacing open surgery as the technique of choice for benign and premalignant lesions of the left pancreas. In most laparoscopic series, the supine decubitus or semilateral position is preferred. A posterior approach with the patient in full right lateral decubitus (PA-FRLD) has been proposed as an alternative.
  
  
  METHODS
  From July 2012 to November 2014 we performed 14 LDPs. PA-FRLD was chosen in 8 patients; in 6 patients splenectomy was also performed.
  
  
  RESULTS
  Definitive diagnoses were 3 cases of pancreatic ductal adenocarcinoma, 2 cases of nonfunctioning neuroendocrine tumors, 1 case of bulky serous cystic neoplasm, 1 case of inflammatory chronic pancreatitis, and 1 case of pancreatic trauma (duct disruption). No conversions were required. No postoperative pancreatic fistula was detected. No patient required transfusion. Two patients had Clavien II and IIIb postoperative complications. In both cases in which preservation of the splenic vessels was attempted, it was successfully achieved.
  
  
  CONCLUSIONS
  The PA-FRLD position is a valid alternative to the supine or semilateral position for LDP. This approach is especially beneficial for resection of complex and bulky lesions of the tail of the pancreas and those in close contact with retroperitoneal organs and can also facilitate spleen-preserving LDP.
authors.affiliation: Unit of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, Hospital del Mar, Autonomous University of Barcelona , Barcelona, Spain .
authors.forename: Ignasi
authors.initials: I
authors.lastname: Poves
authors.affiliation: Unit of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, Hospital del Mar, Autonomous University of Barcelona , Barcelona, Spain .
authors.forename: Fernando
authors.initials: F
authors.lastname: Burdío
authors.affiliation: Unit of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, Hospital del Mar, Autonomous University of Barcelona , Barcelona, Spain .
authors.forename: Luís
authors.initials: L
authors.lastname: Grande
mesh_terms: D000293:Adolescent; D000368:Aged; D021441:Carcinoma, Pancreatic Ductal / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D018297:Neoplasms, Cystic, Mucinous, and Serous / Q000473:pathology / Q000601:surgery*; D018358:Neuroendocrine Tumors / Q000473:pathology / Q000601:surgery*; D010180:Pancreatectomy / Q000009:adverse effects / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000473:pathology / Q000601:surgery*; D010195:Pancreatitis / Q000601:surgery; D056888:Patient Positioning; D013156:Splenectomy / Q000379:methods