Gastroenterology Research and Practice / 2014 / Article / Fig 2

Clinical Study

Hind Right Approach Pancreaticoduodenectomy: From Skill to Indications

Figure 2

Hind right approach PD: after extended Kocher maneuver the duodenopancreas is retracted upwards and medially. Early posterior approach to the SMA (dissection of the MP along the discontinuous line) combined with an early approach to the SMV below the pancreas, where it passes over the third duodenum (the SMV is dissected free from the pancreas and uncinate, the right gastroepiploic and inferior pancreaticoduodenal veins are ligated, and a tunnel is created between the portomesenteric vein and pancreas towards the hepatic pedicle). CBD: common bile duct; GDA: gastroduodenal artery; IVC: inferior vena cava; LRV: left renal vein; P: pancreas; PV: portal vein; SMA: superior mesenteric artery; SMV: superior mesenteric vein.