[Resection of the retroportal pancreatic lamina during a cephalic pancreaticoduodenectomy: first dissection of the superior mesenteric artery]

Abstract

We report a modification of the standard resection of the retroportal pancreatic lamina during pancreaticoduodenectomy. The resection begins with the dissection of the origin of the superior mesenteric artery (SMA) above the left renal vein and a step-by-step section of the retroportal pancreatic lamina on the right side of the SMA, then the pancreatic head is retracted to the left and freed from the portal vein, and lastly the neck of the pancreas is transected. This technique allows a total lymph node clearance, secures the dissection of the SMA, and allows safe identification of anatomic variations like a replaced right hepatic artery originating from the SMA.