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Ligament of Treitz – Images and Surgical Implications during Robotic Whipple Procedure

Anusak Yiengpruksawan, MD, Anthony Pozzessere, MD, Jonas Mansson, MD. The Valley Hospital, Ridgewood, NJ

We present a video showing images of the ligament of Treitz (LT) during robotic Whipple procedure.

LT is a well documented fibromuscular structure that fixes the duodenojejunal flexure to the retroperitoneum around the origin of the SMA and celiac trunk. Although it is well-known structure that is commonly referred to, it has not been clearly seen or shown during surgery.

The goals of this video are to demonstrate the live images of the ligament during the surgery and discuss its roles and significance in surgery.

We retrospectively reviewed all of our recorded videos of robotic Whipples that we performed between July 2007 and July 2016. All cases were done using the daVinci Si system. Segments reviewed included Kocherization, mobilization of DJ flexure, and dissection of uncinate process.

In conclusions, the video showed that LT is a recongnizable fibromuscular structure during DJ dissection. There are several approaches to reach the ligament but the left sided approach may pose more risk in injuring vessels to the uncinate process. For right sided approach, lower part of the uncinate may have to be divided first before the ligament can be safely divided. This approach may be difficult when there is cancer or chronic pancreatitis involving uncinate .


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

Abstract ID: 77978

Program Number: V196

Presentation Session: Video Loop

Presentation Type: VideoLoop

54

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