D-2

1. Kocherization 1
Assistant’s hands holding Assistant’s hands holding
the duodenumthe duodenum
Inf. vena cavaInf. vena cava Transv. colonTransv. colon
22
ndnd
part of the part of the
duodenumduodenum
HeadHead

2. Kocherization 2

3. Kocherization 3
Inf. vena cavaInf. vena cava
Transv. colonTransv. colon
AortaAorta
Lt. renal V.Lt. renal V.
Rt. kidneyRt. kidney

4. Bursectomy
OmentumOmentum
DuodenumDuodenum
Ant. sheet of transv. mesocolonAnt. sheet of transv. mesocolon
Post. sheet of transv. mesocolonPost. sheet of transv. mesocolon

5. Completion of Bursectomy
Pancreatic tailPancreatic tail

6. Exposure of the Gastro-colic Trunk
Middle colic V.Middle colic V.
Acc. rt. colic V.Acc. rt. colic V.
Rt. gastro-epiploic V.Rt. gastro-epiploic V.
Ant. sup. panc. duod. V.Ant. sup. panc. duod. V.
Sup. mesenteric V.Sup. mesenteric V.
Gastro-colic trunkGastro-colic trunk

7. Division of the Right Gastro-epiploic Vein

8. Exposure of the Supra-pyloric Area
Rt. gastric A.Rt. gastric A.
Sup. duodenal A.Sup. duodenal A.
PylorusPylorus

9. Exposure of the Right Gastric Argery
Gastroduodenal A.Gastroduodenal A.
Rt. gastric A.Rt. gastric A.

10. Transection of the Duodenum

11. Dissection of the Upper Border of the Pancreas

12. Identification of the Splenic Artery
Splenic A.Splenic A.
Gastroduodenal A.Gastroduodenal A.
No. 8a LNNo. 8a LN
Common hepatic A.Common hepatic A.

13. Dissection of the No. 12a Nodes
No. 12a LNNo. 12a LN
Common hepatic A.Common hepatic A.
Proper hepatic A.Proper hepatic A.
Portal V.Portal V.

14. Taping of the Common Hepatic Artery

15. Lymphadenectomy along the Splenic Artery
Great pancreatic A.Great pancreatic A.
Splenic V.Splenic V.
Post. gastric A.Post. gastric A.
Splenic A.Splenic A.

16. Ligation of the Splenic Artery

17. Division of the Left Gastric Artery
Lt. gastric A. stumpLt. gastric A. stump

18. Exposure of the Esophageal Hiatus
Diaphragmatic crusDiaphragmatic crus
Post. wall of the cardiaPost. wall of the cardiaPost. vagal trunkPost. vagal trunk

19. Exposure of the Abdominal Esophagus

20. Transection of the Esophagus

21. Mobilization of the Pancreas 1
Pancreatic bodyPancreatic body
SpleenSpleen
Lt. adrenalLt. adrenal

22. Mobilization of the Pancreas 2
Pancreatic tailPancreatic tail
SpleenSpleen
Lt. kidneyLt. kidney

23. Mobilization of the Spleen
SpleenSpleen

24. Completion of Mobilization
SpleenSpleen
StomachStomach

25. Exposure of the Splenic Vein
Splenic V.Splenic V.
Splenic A.Splenic A.
Celiac A.Celiac A.
Lt. gastric A. stumpLt. gastric A. stump
Pancreatic tailPancreatic tail

26. Distal Pancreatectomy

27. Completion of No. 14v Dissection
Sup. mesenteric Sup. mesenteric
V.V.
Acc. rt. colic V.Acc. rt. colic V.
Ant. sup. panc. duod. V.Ant. sup. panc. duod. V.
Middle colic V.Middle colic V.
Rt. gastro-epiploic V. stumpRt. gastro-epiploic V. stump
Tape on the gastro-colic trunkTape on the gastro-colic trunk

28. Esophago-jejunostomy 1

29. Esophago-jejunostomy 2

30. Closure of the Jejunal Stump
EsophagojejunostomyEsophagojejunostomy

31. Jejuno-jejunostomy

32. Completion of Roux-en-Y Reconstruction
Jejuno-jejunostomyJejuno-jejunostomy

33. Closure of the Mesenteric Defect