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Laparascopic pancreaduodenectomy using artery first approach

Palanisamy Senthilnathan, Anand Vijai, V P Nalankilli, G Srivatsan, Sandeep Sabnis, R Parthasarathi, S Rajapandian, C Palanivelu. GEM Hospital & Research Centre

Minimally invasive laparoscopic pancreatoduodenectomy is technically feasible and safe. An artery first approach to pancreatoduodenectomy is a critical technique to assess the SMA involvement by the tumour quite eary in the dissection phase. It also ensures complete oncological clearance around superior mesenteric vessels and also reduces the blood loss during surgery. In this video, we show the technique of laparoscopic pancreatoduodenectmy using artery first approach. The procedure begins with mobilisation of hepatic flexure colon down. The superior mesenteric artery is identified by following the first jejunal branch to the inferior border of pancres. The superior mesenteric vein is skeletonised and spleno portal confluence is dissected. These two menouvers expose the SMA and inferior pancreato duodenal artery (IPDA) is clipped and divided. Subsequently after accessing the operability, duodenum is transected, bile duct and GDA are divided. Complete hepatoduodenal, celiac and uncinate clearance is undertaken. Jejunum is transected, pancreas neck is divided and specimen is removed. Reconstruction is done using duct to mucosa pancreatojejunostomy, heptaticojejunostomy and duodenojejunostomy.


Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 80831

Program Number: V049

Presentation Session: Thursday Exhibit Hall Video Presentations Session 3 (Non CME)

Presentation Type: EHVideo

39

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