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Careful exposure was obtained as the dissection approached the region of the superior mesenteric artery and celiac axis. Exposure is achieved with retraction of the distal tail of the pancreas antero-caudally to expose the posterior cephalic attachments. This part of the pancreas is tethered posteriorly to the celiac region by the splenic artery. The relationship of the left hepatic and gastric left arteries should be considered during dissection in this area. The SMA originates from the aorta just inferior to the celiac axis; anatomic anomalies of the mesenteric vessels are well described. Intraoperative ultrasound is necessary to define vessels in laparoscopy because the surgeon is unable to palpate these structures and assess pulsations.