P.C. Giulianotti
SUMMARY: The pneumoperitoneum is induced with the Verres needle.
The abdominal exploration does not show carcinomatosis and liver metastases. An extensive adhesiolysis till complete exposition of the hepatic hilum is carried out laparoscopically and robotically. Identification and preparation of the jejuanl limb anastomosed with the pancreas and the common bile duct (the patient has undergone a Whipple procedure and developed a biliary stenosis). The bilio-enteric anastomosis is taken down and sent for frozen section (negative for malignancy).
The termino-laterl hepaticojejunostomy is completed with PDS 4.0 – posterior running and anterior interrupted suture -.
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P.C. Giulianotti
SUMMARY: The procedure starts with an intraoperative ultrasonographic study of the liver which confirms the presence of a lesion of 5 cm in diameter in the third segment of the liver. The study reveals also the presence of two lesions: about 1 and 1
P.C. Giulianotti
SUMMARY: Access for the camera and instruments to reach the thyroid and central neck is acquired by an incision in the anterior axillary fold. Elevation of skin
P.C. Giulianotti
Summary:The pneumoperitoneum is induced with the Verres needle.
The abdominal exploration does not show carcinomatosis and liver metastases.
The inferior vena cava is exposed mobilizing the right colon and the duodenum. A lymph node sampling is taken at this level for frozen section (negative).
The gastro-colic ligament is entered and the superior mesenteric vein (SMV) is prepared to rule out neoplastic encasement. Cholecystectomy is carried out with the standard technique. The hepatic hilum is dissected. The main biliary duct is cut upstream of the cystic duct and the gastro-duodenal artery is ligated and cut.
