Hanging spleno-mesenteric confluence - approach to minimal invasive pancreatoduodenectomy

Presenter: Omero Costa Filho MD, MSc | Hospital Militar de Área Porto Alegre (HMAPA) Methods: Description of our conventional technique for LPD using hanging maneuver to expose uncinate process with the principles “artery-first” approach. Results: is performed patient placed in a supine, split-leg position and carefully secured operative table, surgeon on foot between legs, an assistant at each side. A 12-mm Hasson trocar about 16 cm from xyphoid, pneumoperitoneum established. total four additional trocars, two 12 mm 5 mm, are abdomen semi-circular pattern centered around head pancreas. All steps was following institutional protocol we focus time. After switches right side patient, instrument used partially open retract dissect freely splenic mesenteric venous confluence (SMVC). The dissected lateral aspect superior vein (SMV) while small vessels clipped. To best expose, ligate gastrocolic trunk (Henle’s trunk) this Then portal (PV) SMV looped penrose drain number 2 have proximal distal control, if needed, facilitate retraction by left patient. retracted medially penrose. Care must be taken first jejunal vein, that inferior limit start point dissection. SMA can found directly under slightly medial SMV. dissection carried out vessel sealing device. pancreaticoduodenal artery usually ligated clips. During all dissection, release PV done ensure hepatic inflow. When SMVC, hung penrose, mesopancreas nodes take off celiac (CT). complete, en-bloc resection assured, looking CT emergence Abdominal Aorta. Conclusion: This description actual approach but extend robotic pancreatic surgery. We continue track cases improve results secure issues oncology outcomes. Until now, use initial experience spleno-mesenteric show better view SMA. Further evaluation historical cohort may beneficial suggestion such challenge MIS procedure.