A proposed new pancreatic classification system according to segments: Operative procedure for a medial pancreatic segmentectomy

Based on anatomical considerations and our experience in performing segmental resections of the pancreas, we propose here a new pancreatic classification system that divides the pancreas into four segments: posterior, proximal, medial, and distal. We also describe the operative procedures for medial pancreatic segmentectomy, carried out in two patients. Under this new classification system, based on the clinical position of these pancreatic segments, the embryologically termed ventral pancreas is now retermed the posterior segment, while the dorsal pancreas is divided into three segments, termed: the proximal segment (the duodenum-sided segment of the dorsal pancreas that connects with the posterior pancreas), the medial segment (the segment that corresponds with the pancreatic neck), and the distal segment (the area from the left border of the superior mesenteric artery to the hilum of the spleen). Although this division of the pancreas into four segments is a new concept, the development of new and better operative procedures that enable the resection of each pancreatic segment independently has made this concept not only valuable but clinically practical.