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  • The 1 st assistant holds the duodenum and transverse colon to stretch the parietal peritoneum.
  • D-2

    1. 1. Kocherization 1 Assistant’s hands holding the duodenum Inf. vena cava Transv. colon 2 nd part of the duodenum Head
    2. 2. Kocherization 2
    3. 3. Kocherization 3 Inf. vena cava Transv. colon Aorta Lt. renal V. Rt. kidney
    4. 4. Bursectomy Omentum Duodenum Ant. sheet of transv. mesocolon Post. sheet of transv. mesocolon
    5. 5. Completion of Bursectomy Pancreatic tail
    6. 6. Exposure of the Gastro-colic Trunk Middle colic V. Acc. rt. colic V. Rt. gastro-epiploic V. Ant. sup. panc. duod. V. Sup. mesenteric V. Gastro-colic trunk
    7. 7. Division of the Right Gastro-epiploic Vein
    8. 8. Exposure of the Supra-pyloric Area Rt. gastric A. Sup. duodenal A. Pylorus
    9. 9. Exposure of the Right Gastric Argery Gastroduodenal A. Rt. gastric A.
    10. 10. Transection of the Duodenum
    11. 11. Dissection of the Upper Border of the Pancreas
    12. 12. Identification of the Splenic Artery Splenic A. Gastroduodenal A. No. 8a LN Common hepatic A.
    13. 13. Dissection of the No. 12a Nodes No. 12a LN Common hepatic A. Proper hepatic A. Portal V.
    14. 14. Taping of the Common Hepatic Artery
    15. 15. Lymphadenectomy along the Splenic Artery Great pancreatic A. Splenic V. Post. gastric A. Splenic A.
    16. 16. Ligation of the Splenic Artery
    17. 17. Division of the Left Gastric Artery Lt. gastric A. stump
    18. 18. Exposure of the Esophageal Hiatus Diaphragmatic crus Post. wall of the cardia Post. vagal trunk
    19. 19. Exposure of the Abdominal Esophagus
    20. 20. Transection of the Esophagus
    21. 21. Mobilization of the Pancreas 1 Pancreatic body Spleen Lt. adrenal
    22. 22. Mobilization of the Pancreas 2 Pancreatic tail Spleen Lt. kidney
    23. 23. Mobilization of the Spleen Spleen
    24. 24. Completion of Mobilization Spleen Stomach
    25. 25. Exposure of the Splenic Vein Splenic V. Splenic A. Celiac A. Lt. gastric A. stump Pancreatic tail
    26. 26. Distal Pancreatectomy
    27. 27. Completion of No. 14v Dissection Sup. mesenteric V. Acc. rt. colic V. Ant. sup. panc. duod. V. Middle colic V. Rt. gastro-epiploic V. stump Tape on the gastro-colic trunk
    28. 28. Esophago-jejunostomy 1
    29. 29. Esophago-jejunostomy 2
    30. 30. Closure of the Jejunal Stump Esophagojejunostomy
    31. 31. Jejuno-jejunostomy
    32. 32. Completion of Roux-en-Y Reconstruction Jejuno-jejunostomy
    33. 33. Closure of the Mesenteric Defect
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