Abstracts Only
SSAT residents Corner
Find SSAT on Facebook SSAT YouTube Channel Follow SSAT on Twitter
SSAT “How I Do It” Series: Pancreatic Head Resection

The 2016 "How I Do It" Video Series features pancreatic head resection surgeries from Germany, China, Germany, Tokyo,and Greece. Prof Ernst J. M. Klar, MD, SSAT International Relations Committee Chair, introduces this series in the first video, followed by the surgical videos.

Professor Ernst J.M. Klar, MD of the University of Rostock Germany introduces the Society for Surgery of the Alimentary Tract International Relations Committee "How I Do It" Series on Pancreatic Head Resection.




Pylorus-preserving Pancreatoduodenectomy Germany

The Achilles’ heel of pancreatic head resection is the pancreatic anastomosis. We prefer a two-layer end-to-side pancreato-jejunostomy in invagination technique. The prerequisite is an adequate mobilization of the pancreatic remnant to allow for an optimal position of the dorsal seromuscular row of sutures. Part of the dorsal and ventral inner row of single PDS 4-0 sutures are two to three stiches each integrating the pancreatic duct. We include the whole transsection surface into the anastomosis to guarantee drainage also of the small side ducts.

The hepatojejunostomy is performed in parachute-technique with the ventral row of single 5-0 PDS sutures prepositioned on the jejunal side. After approximation the ventral row of sutures can then be completed in back-hand fashion inside-out at the hepatic duct avoiding the back wall with high precision also in small ducts.

We prefer an antecolic duodeno-jejunostomy end-to-side since it may reduce delayed gastric emptying. Intraoperative insertion of a triluminal tube allows early enteral feeding.

Video Contributed to the Society for Surgery of the Alimentary Tract (SSAT) International Relations Committee "How I Do It" Video Series: Pancreatic Resection by: Ernst Klar, MD, FACS Professor and Chairman Department of Surgery




Whipple with PVR in 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.

Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, The Tokyo University Hospital

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




Robotic Whipple China

Video Contributed to the Society for Surgery of the Alimentary Tract (SSAT) International Relations Committee "How I Do It" Video Series: Pancreatic Resection by: Cheng Hong Peng, MD General Surgery of Ruijin Hospital affiliated to Shanghai Jiao Tong University, School of Medicine Shangai, China




"Artery First Approach" Germany

In patients with pancreatic cancer, surgical resection is the only potentially curative therapy. Intraoperatively, resectabilty of the tumour should be assessed as early as possible; in case of infiltration of the superior mesenteric or portal vein these structures should be resected and reconstructed. Aim of the surgical approach is complete (R0-resection) resection of the tumour. Unfortunately, in many cases tumour cells are detected at the resection margin (R1-resection), mostly along the margin to the superior mesenteric artery.

The “Artery first” approach published by our group in the year 2010 (J Am Coll Surg 2010;210:e1-4) and demonstrated in this video, allows early assessment of tumour resectability, aids in vein resection if necessary and potentially improves the rate of complete tumour resection.

This video shows the steps of a laparoscopic subtotal and total gastrectomy with D2 lymphadenectomy. First, the gastrocolic ligament is divided. Then right gastroepiploic and right gastric vessels (along with nodes groups 6-5) are dissected. The duodenum is transected using an endoscopic linear stapler. Lymphadenectomy of groups 8a and 11p is performed, and left gastric vein and artery are divided along with groups 7-9. Resection of groups 1-3 is completed. For a total gastrectomy dissection continues through the greater curvature. Finally, end to side reconstruction is showed with Roux-en-Y esophagojejunostomy for total gastrectomy.and a Billroth II technique for subtotal gastrectomy.

Video Contributed to the SSAT International Relations Committee "How I Do It" Video Series: Pancreatic Head Resection by: Prof. Dr. J. Weitz, MSc, Chairman, Department of Visceral-, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technical University Dresden, Germany




Modified Whipple procedure for Pancreatic Head Carcinoma Greece

In this video we employ our technique of a modified pylorus preserving Whipple procedure. In this technique the pancreaticojejunostomy (PJ) is placed next to the gastrojejunostomy (GJ) on the short limb of a Roux jejunal loop while the hepaticojejunostomy (HJ) was performed on the long limb of the Roux jejunal loop. The GJ is performed at a distance of at least 25cm from the PJ anastomosis. Another 15- 25 cm distally to the GJ, the jejunum was transected and a Roux-en-Y loop was fashioned with the closed end of the transected long loop being anastomosed as an end-to-side HJ. By this surgical technique, contact of bile with PJ is avoided, therefore preventing the deleterious effects on the permeability of the pancreatic ductal system.

Video Contributed to the Society for Surgery of the Alimentary Tract (SSAT) International Relations Committee "How I Do It" Video Series: Pancreatic Resection by: V. Smyrniotis, Professor of surgery; N. Arkadopoulos, Associate professor of surgery; I. Tzanoglou, MD, Surgeon; Correspondence: Nikolaos Arkadopoulos, Associate professor, Rimini 1 street, Chaidari, Greece




Duodenum-Preserving Pancreatic Head Resection (DPPHR) Germany

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: Thilo Hackert; Jörg Rodrian; Markus W. Büchler; Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Germany






Quick Links
About the SSAT
Membership
Pay Membership Dues
Meetings & Education
Patient Care Guidelines
Awards
Foundation
Publications
Advocacy
Donate Today