Whipple (pancreaticoduodenectomy) [case 7]

OR Footage

Summary of surgeons' findings and slowing down moments:

Operating surgeon: Dr. Moulton

  • Critical imaging findings:
    1. Cystic lesions in pancreas head and neck
    2. IPMN (Intraductal Papillary Mucinous Neoplasms)
    3. Adipose tissue
  • Procedure-specific moments:
    1. Assess resectability
    2. Tumor proximity to portal vein
    3. Tumor proximity to superior mesenteric vein
    4. Tumor proximity to hepatic arteries

Consulting surgeon: Dr. Gallinger

  • Critical imaging findings:
    1. Dilated pancreatic duct
    2. First jejunal branches of SMV
  • Procedure-specific moments:
    1. Rule out metastatic lesions
    2. Assess pancreatic structure
    3. Tumor proximity to portal venous structures
    4. Proximity of branches to SMV and neck of pancreas
    5. Tumor proximity to SMA
    6. Any aberrant right hepatic artery

Consulting surgeon: Dr. Shrikhande

  • Critical imaging findings:
    1. Atherosclerotic changes
    2. Pylorus-preserving pancreatoduodenectomy
    3. Dilated pancreatic duct
    4. Assess for IPMN
  • Procedure-specific moments:
    1. Incision, open resection
    2. Assess friability of tissues
    3. Mobilize hepatic flexure, kocherization
    4. Uncinate process and SMV
    5. Identify, dissect the GDA
    6. Dissection of pancreatic neck

Watch the following videos from the operation to see some of the key moments in the case.

Unplanned moment: avulsed middle colic vein
Dissection of retropancreatic tunnel
Pancreatic transection
Dissecting uncinate process off SMV
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