Dr. Felli Lettura: pT2N2 RO Pancreatic adenocarcinoma

Four 8mm robotic ports are placed along a transverse umbilical line.

Two ports, a 12mm and a 5mm one, are used by the assistant.

The greater omentum is divided, starting from the fan-gotham point inferiorly to the gastroepiploic arcade.

Division is progressively performed using a vessel sealing device.

device. Hemlock clips are placed at the level of arteriovenous branches in order to secure

hemostasis. Short gastric vessels are progressively divided between hemlock clips. The lesser

sac is completely opened. The lesser omentum is opened with a hook in order to reach the

celiac region. The lymph node of the common hepatic artery is dissected. The left gastric

artery and the origin of the splenic artery can be seen. Adhesions around the neck of

the pancreas at the posterior aspect of the stomach are taken down with a bipolar forceps.

A tape is passed to track the stomach superiorly, completely exposing the isthmus, body and

tail of the pancreas. Adhesions are taken down distally from the tumor. A bursi forceps

is used to exteriorize the tape. The vicral suture is used to exert traction on the round

ligament and on the falciform ligament opposite the splenic flexure. The splenicolic ligament

is divided and the splenic flexure is lowered using a hook. The left gastroepiploic artery

is divided and hemlock clips are placed. The splenic flexure is lowered exposing the anterior

part of gyrotus fascia. The transverse mesocolon is divided away from the tumor. Our attention is

then turned to the proximal portion of the transverse mesocolon. The duodenal-jejunal

flexure is visible and the ligament of trites is divided. The division is continued exposing

exposing the pancreatic isthmus, the common hepatic artery, the gastroduodenal artery

and the portal vein posteriorly.

The lymph nodes of the gastric artery and the gastric vein are dissected.

The splenic vein is then divided between hemlock clips.

Lymph node dissection is pursued.

The origin of the splenic artery is progressively isolated.

The splenic artery is divided between hemlock clips.

Here we cannot retract the pancreatic isthmus inferiorly.

A small dorsal pancreatic artery coming from the origin of the common hepatic artery

is divided between hemolytic clips. Dissection of the supra-ismic portal vein is continued.

Our attention is then turned towards the inferior part of the pancreatic isthmus

to isolate the terminal part of the superior mesenteric vein and to obtain a retro-ismic

passage and achieve vascular control. Here is the retro-ismic passage. A tapis

pass to exert traction on the pancreatic isthmus. The pancreas is divided slowly

and very progressively using a laparoscopic 60mm endogia linear

stapler black cartridge. A lateral superior traction is exerted on the

pancreas. The terminal part of the inferior mesenteric vein is isolated and

divided between hemlock clips. It will be resected and blocked with a specimen. The

pancreas is traction superiorly in order to isolate the terminal part of the

the splenic vein. The vein is ligated using Vicral 3-0 to reduce the caliber and place

hemlock clips. The splenic vein is then divided. Lateral traction is placed on the specimen

and the superior and left lateral borders of the superior mesenteric artery are dissected

vertically and freed progressively. The left border of the celiac trunk is freed along with

with a progressive left splanchnisectomy.

The dissection is continued posteriorly until the anterior aspect of the left renal vein

is accessed, which is freed.

The freeing is performed from caudally to cranially, entering Jotter's fascia.

Superiorly, the left border of the celiac trunk is freed progressively.

The left diaphragmatic crust is exposed.

Dissection is pursued on the left border of the aorta.

The left adrenal vein is isolated and divided between hemlock clips.

progressive dissection is achieved anterior to the left renal capsule and the anterior renal

fascia is completely dissected one last short gastric vessel is divided the anterior part of

the left kidney is exposed the last remaining peritoneal attachments between the spleen and

the diaphragm are divided the celiac nodes are resected the specimen is introduced into an

endobag and removed through a fan and steels incision. A tachycele patch is

placed at the level of the pancreatic division line. A drainage is placed near

the pancreatic stump. The omentoplasty is performed.