Operative Notes
Indications of Median Pancreatectomy
Small pancreatic tumors (less than 5 cm)
Neuroendocrine tumors in neck and body of pancreas
Small cystic tumors neck and body of pancreas
Distal residual stump
Position
1. Patient is placed supine and Bilateral subcostal incision is given
2. Abdomen is explored and metastasis ruled out
3. Kocherization done
4. Head of pancreas and status of superior mesenteric artery and vein is checked
5. GastroColic omentum is cut, lesser sac opened and pancreas separated from Superior Mesenteric vein, Middle colic vein may or may not be divided.
6. The tunnel between portal vein and pancreas is developed in the usual way
7. Porta is dissected and Common hepatic artery, right gastric artery and Gastroduodenal artery are exposed.
8. Splenic flexure of colon is mobilized
9. Intraoperative ultrasoind is used to assess the lesion, liver and pancreas.
10. Pancreas is dissected posteriorly at the superior border.
11. The dorsal pancreatic artery is dissected and preserved, if large this forms the supply of distal segment
12.Pancreatic parenchymal division may be done using CUSA, harmonic scalpel or diathermy
13.Main pancreatic duct is ligated at the distal part of the head
Reconstruction
Distal pancreas- Roux enY jejunal limb
Surgery Resources
Median Pancreatectomy is relatively new surgery for small tumors in body and neck of pancreas