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Kocherization 1 Assistant’s hands holding the duodenum Inf. vena cava Transv. colon 2 nd  part of the duodenum Head
Kocherization 2
Kocherization 3 Inf. vena cava Transv. colon Aorta Lt. renal V. Rt. kidney
Bursectomy Omentum Duodenum Ant. sheet of transv. mesocolon Post. sheet of transv. mesocolon
Completion of Bursectomy Pancreatic tail
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
Division of the Right Gastro-epiploic Vein
Exposure of the Supra-pyloric Area Rt. gastric A. Sup. duodenal A. Pylorus
Exposure of the Right Gastric Argery Gastroduodenal A. Rt. gastric A.
Transection of the Duodenum
Dissection of the Upper Border of the Pancreas
Identification of the Splenic Artery Splenic A. Gastroduodenal A. No. 8a LN Common hepatic A.
Dissection of the No. 12a Nodes No. 12a LN Common hepatic A. Proper hepatic A. Portal V.
Taping of the Common Hepatic Artery
Lymphadenectomy along the Splenic Artery Great pancreatic A. Splenic V. Post. gastric A. Splenic A.
Ligation of the Splenic Artery
Division of the Left Gastric Artery Lt. gastric A. stump
Exposure of the Esophageal Hiatus Diaphragmatic crus Post. wall of the cardia Post. vagal trunk
Exposure of the Abdominal Esophagus
Transection of the Esophagus
Mobilization of the Pancreas 1 Pancreatic body Spleen Lt. adrenal
Mobilization of the Pancreas 2 Pancreatic tail Spleen Lt. kidney
Mobilization of the Spleen Spleen
Completion of Mobilization Spleen Stomach
Exposure of the Splenic Vein Splenic V. Splenic A. Celiac A. Lt. gastric A. stump Pancreatic tail
Distal Pancreatectomy
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
Esophago-jejunostomy 1
Esophago-jejunostomy 2
Closure of the Jejunal Stump Esophagojejunostomy
Jejuno-jejunostomy
Completion of Roux-en-Y Reconstruction Jejuno-jejunostomy
Closure of the Mesenteric Defect

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D-2

Editor's Notes

  1. The 1 st assistant holds the duodenum and transverse colon to stretch the parietal peritoneum.