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Title
1. Incision and Exposure
2. Extended Kocher Maneuver
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a. Identify Inferior Vena Cava
b. Inspect Ligament of Treitz and Inferior Mesenteric Vein
c. Inspect Duodenum, Head of Pancreas, and Tumor
d. ID & Ligate Branches of Superior Mesenteric Vein to Pancreas, to Colon, and to Stomach
3. Cholecystectomy and Portal Dissection
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a. Retrograde Mobilization of Gallbladder
b. Identify Common Bile Duct
c. Divide Common Bile Duct above Insertion of Cystic Duct
d. Dissect Bile Duct Inferiorly to Insertion into Pancreas
e. Identify Gastroduodenal Artery and Relationship to Hepatic Artery
4. Mobilization and Transection of Duodenum and Pancreas
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a. Mobilize Duodenum
b. Identify and Divide Right Gastric and Gastroepiploic Arteries
c. Divide Duodenum Distal to Pylorus
d. Reflect Duodenum and Pancreatic Head to Show Pancreatic Neck
e. Divide Pancreas at Level of Neck
f. Identify Pancreatic Duct
5. Mobilization and Division of Jejunum
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a. Identify Ligament of Treitz
b. Divide Mesentery Distal to Ligament from Jejunum
c. Divide Jejunum
d. Mobilize Mesentery Proximal to Ligament of Treitz
e. Reflect Duodenum and Head of Pancreas under Root of Mesentery
f. Mobilize Uncinate Process Off of Mesenteric Vessels
g. Divide Inferior Pancreaticoduodenal Artery
h. Remove Specimen with En Bloc Duodenum and Head of Pancreas
i. Oversew Defect at Ligament of Treitz
6. Pancreaticojejunostomy
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a. Evert Sutures Placed in Pancreatic Duct
b. Create Enterotomy in Jejunum
c. Place Stent through Enterotomy and into Pancreatic Duct
d. Perform Anastomosis
7. Hepaticojejunostomy
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a. Create Enterotomy in Jejunum Distal to Pancreatic Anastomosis
b. Perform Anastomosis
8. Duodenojejunostomy
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a. Close Mesentery Defect
b. Begin Anastomosis
c. Anastomosis Complete
9. Closure
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a. Place Blake Drains
b. Close Mesentery over Enterotomy
c. Close Wound
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Whipple Procedure for Multiple Endocrine Neoplasia of the Pancreas
Keith Lillemoe, MD
,
Andrew Loehrer, MD
Massachusetts General Hospital
Tags:
General Surgery
Oncologic Surgery
Main Text
Procedure Outline
Transcript
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Authors
Keith Lillemoe, MD
Andrew Loehrer, MD
Filmed At:
Massachusetts General Hospital
Article Information
Publication Date
12/3/2018
Article ID
16
Production ID
0079
Volume
2018
Issue
16
DOI
https://doi.org/10.24296/jomi/16