Fig. 4

A The right lateral decubitus position and the 11th and 12th free ribs were partially resected under the 7 cm in size of incision. B The retroperitoneal space was widely dissected near the abdominal aorta (arrows), and the left iliac artery and vein were encircled by vessel tapes (red and blue, respectively). C En bloc dissection of the SCN with the spleen (SP) and pancreas body (thick arrow). D The tumor could be completely rotated, and the splenic artery (SA) and vein (SV) trunks were taped. The pancreas body was also mobilized. E The scheme of step-by-step additional incision by attempting minimum wound. By the right hemi-lateral position, the first retroperitoneal access between the 11th intercostal space was cut as incision 1 for 7 cm in size of incision. After retroperitoneal dissection, the 12-cm-length incision 2 up to the vertex of intraabdominal tumor extension was added. To reach the upper and lower tumor edges for removing out of abdominal cavity, the 10-cm-length paramedian incision 3 was finally required