RAMPS Surgery (Radical Antegrade Modular Pancreatosplenectomy)
MCQ Surgery
High-yield: RAMPS is an advanced distal pancreatectomy technique for left-sided pancreatic cancer with superior posterior margin clearance.
What is RAMPS Surgery?
RAMPS (Radical Antegrade Modular Pancreatosplenectomy) is a modification of distal pancreatectomy designed for pancreatic body tumors and tail malignancies. It involves medial-to-lateral dissection with emphasis on achieving negative posterior margins and optimal lymph node clearance.
Indications
- Left-sided pancreatic cancer (body and tail)
- Pancreatic adenocarcinoma
- Neuroendocrine tumors
Types of RAMPS
Anterior RAMPS
- Dissection anterior to adrenal gland
- Adrenal preserved
Posterior RAMPS
- Includes adrenal gland
- Deeper retroperitoneal dissection
Detailed Operative Steps
- Exploration to rule out metastasis
- Enter lesser sac via gastrocolic ligament
- Early ligation of splenic artery
- Pancreatic neck transection over portal vein
- Control of splenic vein
- Lymphadenectomy along celiac axis and hepatic artery
- Selection of posterior plane (key step)
- Retroperitoneal dissection medial → lateral
- En bloc resection with spleen ± adrenal
- Hemostasis and drain placement
RAMPS vs Distal Pancreatectomy
- RAMPS → better posterior margin clearance
- RAMPS → higher lymph node yield
- Distal pancreatectomy → simpler but less oncologically radical
Complications
- Pancreatic fistula
- Postoperative bleeding
- Delayed gastric emptying
- Intra-abdominal infection
Pancreas Learning Hub
Explore Pancreas Surgery MCQs and Notes
MCQ
Most critical step in RAMPS?
Answer: Selection of posterior dissection plane
Answer: Selection of posterior dissection plane