Isolated PD Combined with PV Resection and Preservation of LGV and IMV Under Nakao Mesenteric Approach for Pancreatic Head Cancer, and Covering the Stump of GDA Using Umbilical Vein

Akimasa Nakao, MD, FACS

Product Details
Product ID: ACS-5630
Year Produced: 2018
Length: 10 min.


Seventy years old female patient with pancreatic head cancer was introduced to our institute. Pancreatic head cancer invaded to the spleno-portal confluence without arterial invasion and distant metastasis. The laparotomy was done by upper midline skin incision. The first step in the isolated pancreatoduodenectomy (PD) is mesenteric approach. The Nakao mesenteric approach involves clearance of the connective tissues around the SMV and SMA in the mesenteric root, which include systematic lymphadenectomy around the SMA. The IPDA arising from the SMA is ligated and divided first. The first and second portion of the pancreatic head nerve plexus (mesopancreas) is completely resected. After completion of the mesenteric approach, typical procedures were performed. The spleno-portal confluence is resected. The splenic vein was ligated and divided without reconstruction. The left gastric vein which flows into the portal trunk was preserved to reduce gastric venous congestion. The portal vein was reconstructed by end-end anastomosis between PV and SMV. The stump of the GDA was covered using umbilical vein to reduce the incidence of the bleeding due to pancreatic fistula. In this video, we introduce non-touch isolation (Isolated) PD combined with portal vein resection under the Nakao mesenteric approach and covering the stump of the GDA using umbilical vein.