How I Do It Video: Whipple with PVR Tokyo скачать в хорошем качестве

How I Do It Video: Whipple with PVR Tokyo

The superior mesenteric artery (SMA) first approach has been advocated in Whipple procedure to reduce the blood loss. In this approach, the nerve plexus of SMA is divided and the root of the common trunk of inferior pancreatico-duodenal artery should be ligated at the beginning of operation. The right half of the nerve plexus of SMA is removed to secure enough surgical margin. The patient was a 70’s year old female with a pancreatic head cancer attached to the portal vein. Whipple procedure with resection of the portal vein was performed. She had a past history of left nephrectomy, thus the left renal vein graft could be used as a venous graft. The common hepatic artery had a common trunk with the SMA (hepato-mesenteric trunk). Duodenum-preserving pancreatic head resection (DPPHR) is a parenchyma-sparing resection procedure for non-malignant head lesions in chronic pancreatitis. Three major modifications are established today, namely the Beger, Frey and Berne techniques. The Berne modification, which is shown in the video presentation, is characterized by a resection of all fibrotic and calcified tissue in the pancreatic head with a wide opening and decompression of the pancreatic duct and possibly the bile duct when necessary. An important advantage of the Berne procedure is that no transection of the pancreas above the mesenteric vein is required, which is often difficult due to the chronic inflammatory changes. The video demonstrates background, typical findings and the operative key steps of the Berne modification of DPPHR. Video Contributed to the Society for Surgery of the Alimentary Tract (SSAT) International Relations Committee "How I Do It" Video Series: Pancreatic Resection by: Yoshihiro Sakamoto, Junichi Arita, Norihiro Kokudo Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, The Tokyo University Hospital Visit www.ssat.com to learn more about the Society for Surgery of the Alimentary Tract.