Langenbeck's Archives of Surgery

, Volume 404, Issue 2, pp 247–252 | Cite as

Left kidney mobilization technique during radical antegrade modular pancreatosplenectomy (RAMPS)

  • Genki Watanabe
  • Hiromichi ItoEmail author
  • Takafumi Sato
  • Yoshihiro Ono
  • Yoshihiro Mise
  • Yosuke Inoue
  • Yu Takahashi
  • Akio Saiura
How-I-Do-It article



Radical antegrade modular pancreatosplenectomy (RAMPS) has been accepted as a standard operation for distal pancreatic cancer. While enbloc retroperitoneal dissection in the “medial to lateral” direction is one of the most important steps in this oncologic procedure, it is technically challenging due to the depth of organs under the left costal margin, and poor exposure of the resecting organs in this area will increase the risk of incomplete oncologic dissection.


To improve exposure of the left upper quadrant organs, left kidney was completely mobilized during RAMPS, and all the left upper quadrant organs were elevated and medialized by lap sponges packed in the retro-renal space. The operative and oncologic outcomes for patients who underwent our modified RAMPS with left kidney mobilization were evaluated.


One hundred and forty-four patients with distal pancreatic cancer underwent this procedure from 2005 through 2016. The median operation time was 310 min (range, 132–899), and blood loss was 440 ml (25–2430). There was no complication associated to left kidney mobilization. The median number of harvested lymph nodes was 27 (3–87). While 77% of the tumors had microscopic retroperitoneal invasion, 96% of patients achieved negative retroperitoneal margin.


Left kidney mobilization is useful for safe and oncologically sound lateral retroperitoneal dissection during RAMPS for distal pancreatic cancer.


Radical antegrade modular pancreatosplenectomy Kidney mobilization Surgical technique Distal pancreatic cancer 


Authors’ contributions

GW—conception or design of the work AND drafting of the work.

HI—conception or design of the work AND drafting AND critical revision of the work.

TS—conception or design of the work AND critical revision of the work.

YO—conception or design of the work AND critical revision of the work.

YM—conception or design of the work AND critical revision of the work.

YI—conception or design of the work AND critical revision of the work.

TI—conception or design of the work AND critical revision of the work.

YT—conception or design of the work AND critical revision of the work.

AS—conception or design of the work AND critical revision of the work.

All authors approved the version of the manuscript to be published and agreed to be accountable for all aspects of the work. None of the authors have any actual or potential conflict of interest in relation to the submission of this article.

Compliance with ethical standards

Conflict of interest

The authors declare that there is no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual patients included in the study.

Supplementary material


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Genki Watanabe
    • 1
  • Hiromichi Ito
    • 1
    Email author
  • Takafumi Sato
    • 1
  • Yoshihiro Ono
    • 1
  • Yoshihiro Mise
    • 1
  • Yosuke Inoue
    • 1
  • Yu Takahashi
    • 1
  • Akio Saiura
    • 1
    • 2
  1. 1.Division of Hepatobiliary and Pancreatic Surgery, Japanse Foundation for Cancer ResearchCancer Insitute HospitalTokyoJapan
  2. 2.Department of SurgeryJuntendo University HospitalTokyoJapan

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