Background <p>The standard technique in minimally invasive distal pancreatectomy (MIDP) has not yet been established. While the left renal vein (LRV) is a critical anatomical landmark for defining the posterior surgical margin, safe and reliable approaches to access the LRV have not been thoroughly investigated. This study aimed to evaluate whether the perinephric vein could serve as a landmark to guide access to the LRV and assist in determining the posterior surgical margin.</p> Methods <p>Computed tomography images were retrospectively reviewed in consecutive patients who underwent MIDP at our institute between January 2022 and September 2024. Perinephric veins were categorized into three patterns based on the inflow location into LRV: superior, middle, and inferior types. The middle and inferior types were identified as landmark veins.</p> Results <p>Among 114 patients included in this study, 72 patients (63.2%) were diagnosed with pancreatic ductal adenocarcinoma. Perinephric veins were visible in 105 patients (92.1%). Regarding the perinephric vein patterns, superior, middle, and inferior types were observed in 33 (28.9%), 70 (61.4%), and 2 (1.7%) patients, respectively. Landmark veins were identified in 72 patients (63.2%) and all of them were useful for securing the surgical margin.</p> Conclusion <p>Perinephric vein was identified as a novel landmark vein in more than half of patients who underwent MIDP. This vein can facilitate safe access to the left renal vein and ensure adequate posterior surgical margin, contributing to improve surgical precision.</p> Graphical Abstract <p></p>