Open Distal Pancreatectomy for Pancreatic Cancer

1. Introduction

2. Incision and Access to the Abdominal Cavity

3. Abdominal Exploration to Rule out Metastasis

4. Open Lesser Omentum to Expose the Pancreas

5. Hepatic Artery Exposure

1. Preaortic Tissue Biopsy for Frozen

6. Follow Hepatic Artery to Celiac Trunk and Splenic Artery

1. Harvest Celiac Lymph Nodes

7. Develop Plane Behind Pancreas

8. Pancreas Transection

1. Send Additional Transection Margin for Frozen Section to Confirm Negative Margins

9. Splenic Vessels Identification and Division

1. Tie and Divide Splenic Artery Before Splenic Vein

10. Develop Retropancreatic Plane over the Renal Vein Following it to the Left

11. Approach Through the Gastrocolic Omentum, Taking Down Short Gastrics and Mobilizing the Spleen to Deliver the Specimen

12. Hemostasis

13. Closure

14. Post-op Remarks