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Title
1. Exposure and Approach
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a. Abdominal Midline Incision
b. Inspect Peritoneum
c. Duodenum Identified; Perform Kocher Maneuver
2. Inspection/Identification of Structures Behind Duodenum
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a. Check for Lymphadenopathy
b. Inspection and Palpation of SMA
c. Inspection of Transverse Mesocolon
d. Define Middle Colics
e. Dissect SMV from Under Neck of Pancreas
3. Cholecystectomy
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a. Retrograde Gallbladder Mobilization
b. Cystic Artery Cauterized
c. Cystic Duct Mobilized and Transected
4. Management of Porta Hepatis
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a. Lesser Sac Entered by Incision of Lesser Omentum
b. Incise Peritoneum Overlying Porta Hepatis
c. ID Hepatic Artery, ID Hepatic Duct Joining with Cystic Duct Forming Common Bile Duct
d. Transect Common Bile Duct and Gastroduodenal Artery
5. Mobilization/Division of Proximal Extent of Duodenum
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a. Mobilize Pylorus and Perform Partial Omentectomy
b. Divide Stomach 2 cm Proximal to Pyloric Valve
6. Mobilization/Division of Jejunum
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a. Division of Jejunum
b. Mobilize Ligament of Treitz
7. Mobilization/Division of Pancreas
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a. Divide Pancreas
b. Mobilize Head and Uncinate Process off Portal Vein and SMV
c. Specimen Removed and Margin Marked
8. Reconstruction
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a. Identify Pancreatic Duct
b. Pancreaticojejunostomy and Place Silastic Stent
c. Hepaticojejunostomy
d. Gastrojejunostomy
e. Place G-J Tube Through LUQ Incision
f. Perform Gastrostomy and Thread Tube
9. Closure
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a. Fascial Closure with Running #1 PDS
b. Skin Approximated with Staples
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Whipple Procedure for Carcinoma of the Pancreas
Martin Goodman, MD
1
;
Vahagn G. Hambardzumyan, MD
2
1
Tufts University School of Medicine
2
Yerevan State Medical University, Heratsi Hospital Complex
Tags:
General Surgery
Oncologic Surgery
Main Text
Procedure Outline
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Authors
Martin Goodman, MD
Vahagn G. Hambardzumyan, MD
Filmed At:
Tufts University School of Medicine
Article Information
Publication Date
1/2/2025
Article ID
15
Production ID
0067
Volume
2025
Issue
15
DOI
https://doi.org/10.24296/jomi/15