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Descriptions:
Analysis of Video
Presenter: Dr. Prasad Wagle, Lilawati Hospital, Mumbai
Organization: Lilawati Hospital, Mumbai
Video Source: Edusurg Clinics
Video Link: https://www.youtube.com/watch?v=ENIJbdcjVYE
Year of Posting: 2021
Case Details: Available
Type of Video: Edited
Duration: 19 minutes
Step of Surgery: Not Written
Audio commentary: No. This is the only missing in this video.
Questions & Answers: No
USP of Video:
1. Imposing images of organs or vessels during dissection, gives viewers a better understanding of dissection
2. Portal Vein tunneling is started from the superior border of the pancreas.
3. Pancreas neck transection is done by electrocautery.
This video on step-by-step pancreatic cancer surgery focuses on a Whipple procedure or a classical pancreaticoduodenectomy and elaborates on the Modified Blumgart technique of pancreaticojejunostomy.
The patient had a resectable periampullary mass with elevated Ca 19.9 and bilirubin levels of 5/4.5. He had no other comorbidities except hypothyroidism. No preoperative biliary drainage was performed.
Whipple procedure for pancreatic cancer begins with appropriate preoperative planning and then execution during surgery. This patient had a replaced right hepatic artery and this was known preoperatively. The key steps as shown in the video include
– Assessment for metastatic disease.
– Kocherization
– Creation of superior and inferior retropancreatic tunnel
– Identification of gastroduodenal artery, its clamp test, and then ligation leaving a stump
– Stepwise uncinate dissection at different parts of the Whipple procedure
– Anastomosis by Modified Blumgart technique for pancreaticojejunostomy and single-layer interrupted hepaticojejunostomy.
Then, a stapled retro gastric antecolic gastrojejunostomy was performed followed by drain placement and closure.
Histopathologically, the tumor was well-differentiated adenocarcinoma with all margins free and all nodes/12 negative. The patient was discharged on the 7th day on a normal diet uneventfully.
