Technical details of a left-side approach to the superior mesenteric artery during pancreaticoduodenectomy

Abstract

Background and purpose: To describe the procedure for a left-side approach to the superior mesenteric artery (SMA) during pancreaticoduodenectomy (PD) in a cadaveric study.

Operative procedure: After dividing the upper jejunum, the jejunal artery (JA) is followed to its origin. At the cranial side of the JA, the mesojejunum to be dissected is detached from the ventral to the dorsal side and from the peripheral to the origin side of the SMA. The inferior pancreatoduodenal artery (IPDA), which is usually the common trunk of the IPDA and the first JA, is able to be visualized at the cranio-dorsal side of the origin of the JA. After cutting the IPDA, the mesojejunum can be detached from the SMA from the dorsal aspect to the right side. Subsequently, the pancreas head is dissected easily from the right aspect of the SMA.

Conclusion: This left-side approach to the SMA may become a standard procedure.

Keywords: Cadaver; Inferior pancreaticoduodenal artery; Superior mesenteric artery.