The Video Content has been made available for educational purposes only for surgical training of SIRIRAJ surgical resident and HPB fellowship training program**
Regarding SMA first approach, there were various technique that could be used to assess the resectability. This VDO demonstrates the medial uncinate approach for pancreaticoduodenectomy, which is a good method that can reveal SMA invasion from pancreatic cancer at uncinate process and head of pancreas at the very beginning of the procedure. Moreover, by this technique, mesopancreas (A.K.A, pancreatic head nerve plexus 2) could be identified and dissected free from SMA which is important point to obtain negative SMA margin.
This is nearly uncut VDO. VDO speed was 2x,. In the beginning of this VDO are gastrocolic ligament transection and Kocherization, which were played in 4x speed, you can skip these parts. Important structures and surgical landmarks were labeled in video. Important steps were marked as chapters in timeline and medial uncinate approach begin at time 10:00
Please enjoy.
Chapters
0:00 Begin operation
0:05 Gastrocolic ligament transection
10:00 Gastrocolic trunk division
12:45 Tunnelling SMV
12:55 Begin medial uncinate approach ***
31:57 Duodenal transection
32:20 Hepatoduodenal ligament dissection
35:55 GDA division
43:25 CHD was encircled
44:30 Proximal jejunum transection
49:26 Pancreatic neck transection
56:05 CHD transection
56:51 Important structure after complete specimen removal
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