Whipple

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.