A novel laparoscopic approach to lesions related to the posterior aspect of the pancreatic head |
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Authors: | Alberto Martí nez-Isla,P. Sahle Griffith,Haridimos Markogiannakis,Rachel Clough,Tasha A.K. Gandamihardja,Kamran Qurashi,Panagiotis B. Kekis |
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Affiliation: | a Department of Upper Gastrointestinal and Laparoscopic Surgery, Ealing Hospital, Ealing Hospital NHS Trust, London, UK b Department of Surgery, Queen Elizabeth Hospital, Bridgetown, Barbados c Department of Endocrine Surgery, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK d Athens Medical Centre, Athens, Greece |
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Abstract: | The posterior aspect of the pancreatic head has proven to be a technically demanding region to approach laparoscopically. Previously, this region was approached through the gastrocolic ligament with the patient in a left semilateral position. We believe that this makes the laparoscopic approach to the posterior pancreatic head extremely difficult. In the technique presented here, which has been successfully used in 4 patients, the patient was in full left lateral position, and Nathanson retractors were used to retract the liver and right kidney. This allowed full exposure of the second part of the duodenum before any major dissection. The duodenum was then Kocherized, and the posterior aspect of the pancreatic head, along with the inferior vena cava, left renal vein, and aorta, was exposed. We describe here a safe and feasible laparoscopic method for access to and management of lesions related to the posterior aspect of the pancreatic head. |
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Keywords: | Kocherization Kocherized Laparoscopic pancreatic surgery Left lateral decubitus Posterior pancreatic head |
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