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Laparoscopic pancreatoduodenal resection with preserving of pylorus

Laparoscopic pancreatoduodenal resection with preserving of pylorus.
Professor Israilov R.E. is performing an operation.

Video of operation starts with the observation of the surgical site by fixing liver to the anterior abdominal wall, using the round ligament and needles for stitching troacar wounds. After transection of the gastrocolic ligament by an ultrasonic scalpel adhesioviscerolysis in omentum sac is performed. Then mobilization of the inferior edge of pancreas is performed with the visualization of the superior mesenteric vein (SMV). Then transection of the right gastroomental vessels (GOV) and the initial part of the duodenum is performed. After mobilization of duodenum according to Kocher its transection is done in the proximal part. After that mobilization of the elements of the hepatoduodenal ligament (HDL) is performed. After clipping the gastroduodenal artery is transected. Then small colon is transected, mobilization of the uncinate process is done, lymphadenectomy along the superior mesenteric artery is performed. Choledoch is transected by scissors, the edges of the bile duct and pancreas are sent for urgent histological investigation. 3 anastomoses have been formed in a consecutive order: invaginational pancreatoenteroanastomosis, is stitched by the interrupted suture, using TiCron 2-0 thread, and hepaticojejunoanastomosis, stitched by the continuous suture and duodenoenteroanastomosis, stitched, using two-layer intestinal technique. 2 drains have been placed into the abdominal cavity: to hepaticojejunoanastomosis and pancreatojejunoanastomosis.

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