View
219
Download
0
Category
Preview:
Citation preview
7/23/2019 Pancreatic Transplant Tecnique
http://slidepdf.com/reader/full/pancreatic-transplant-tecnique 1/25
!"#$%&'(") +%, -./#(."0"%1 2./0 ,"#"+)",
,/%/.3 4 5(.6&#+7 +%+1/08 /2 0(794/.6+% ."1.&":+7;
<+%#."+9# ."1.&":+7 2./0 #+,+:".&#
,/%/.
7/23/2019 Pancreatic Transplant Tecnique
http://slidepdf.com/reader/full/pancreatic-transplant-tecnique 2/25
<+%#."+) ."1.&":+7 &% 0(794/.6+% ,/%/.
•
=/)1 -+%#."+) ,/%/.) +." +7)/ 7&:". ,/%/.)3
–
5$+." -/.1+7 :"&% +%, +.1".&+7 )(--78
•
!.&-7" >.1".&+7 :+)#(7+.&?+9/% 2/. 1$" -+%#."+);
–
5-7"%&# +.1".8 @5>A –
B+)1./,(/,"%+7 +.1".8 @BC>A
–
5(-".&/. 0")"%1".&# +.1".8 @5=>A3
7/23/2019 Pancreatic Transplant Tecnique
http://slidepdf.com/reader/full/pancreatic-transplant-tecnique 3/25
SMAIPDA:
inferior pancreatoduodenal artery
(anterior and posterior arcades)SMA
7/23/2019 Pancreatic Transplant Tecnique
http://slidepdf.com/reader/full/pancreatic-transplant-tecnique 4/25
GDASPDA:
7/23/2019 Pancreatic Transplant Tecnique
http://slidepdf.com/reader/full/pancreatic-transplant-tecnique 5/25
SA
7/23/2019 Pancreatic Transplant Tecnique
http://slidepdf.com/reader/full/pancreatic-transplant-tecnique 6/25
KEY POINTS
TO REMEMBER
Dorsal Pancreatic Artery.
Inferior Pancreatoduodenal Artery.
7/23/2019 Pancreatic Transplant Tecnique
http://slidepdf.com/reader/full/pancreatic-transplant-tecnique 7/25
1. Open abdomen cruciate incision.
2. Open the lesser sac and
inspect the pancreas:- Soft,
- no edema,- no fatty infliltration
7/23/2019 Pancreatic Transplant Tecnique
http://slidepdf.com/reader/full/pancreatic-transplant-tecnique 8/25
3. Open the gastrohepatic
ligament and inspect arterial
anatomy of the liver:
Replacement arteries
4. Identify Common bile
duct and the GDA
5. Identify with vessel
loop Splenic A.
7/23/2019 Pancreatic Transplant Tecnique
http://slidepdf.com/reader/full/pancreatic-transplant-tecnique 9/25
!" DE1"%,", F/#$". 0+%/(:".G 7//H
2/. ."-7+#", I&6$1 J"-+9#
+.1".8 @7+1".+7 1/ 1$" KLCA3
M3 N,"%928 .//1 /2 1$" 5=> O&1$
:"))"7 7//- 3
PQ/ 1/(#$ 1"#$%&'("R 1/ 0&%&0&?"-+%#."99)3
S3 =/:&7&?" )-7""% 0",&+778 (- 1/ 1$"
)-&%" &% 1$" +:+)#(7+. -7+%"
-/)1".&/. 1/ 1$" -+%#."+)3
7/23/2019 Pancreatic Transplant Tecnique
http://slidepdf.com/reader/full/pancreatic-transplant-tecnique 10/25
T3 DE1"%,", F/#$". 0+%/(:".G 7//H
2/. ."-7+#", I&6$1 J"-+9#
+.1".8 @7+1".+7 1/ 1$" KLCA3
M3 N,"%928 .//1 /2 1$" 5=> O&1$
:"))"7 7//- 3
PQ/ 1/(#$ 1"#$%&'("R 1/ 0&%&0&?"-+%#."99)3
S3 =/:&7&?" )-7""% 0",&+778 (- 1/ 1$"
)-&%" &% 1$" +:+)#(7+. -7+%"
-/)1".&/. 1/ 1$" -+%#."+)3
7. Identify root of the SMA with
vessel loop.
VC Ao
L renal vein
SMA
7/23/2019 Pancreatic Transplant Tecnique
http://slidepdf.com/reader/full/pancreatic-transplant-tecnique 11/25
T3 DE1"%,", F/#$". 0+%/(:".G 7//H
2/. ."-7+#", I&6$1 J"-+9#
+.1".8 @7+1".+7 1/ 1$" KLCA3
M3 N,"%928 .//1 /2 1$" 5=> O&1$
:"))"7 7//- 3
PQ/ 1/(#$ 1"#$%&'("R 1/ 0&%&0&?"-+%#."99)3
$" =/:&7&?" )-7""% 0",&+778 (- 1/ 1$"
)-&%" &% 1$" +:+)#(7+. -7+%"
-/)1".&/. 1/ 1$" -+%#."+)3
7/23/2019 Pancreatic Transplant Tecnique
http://slidepdf.com/reader/full/pancreatic-transplant-tecnique 12/25
%" N)/7+1" )(-.+#"7&+# +/.1+ 2/.
#7+0-&%63 @!$/.+#&# #7+0-&%6A
&'" K+%%(7+9/% /2 1$" -/.1+7 :"&%
1$./(6$ 1$" &%2".&/. 0")"%1".&#
:"&%3
&&" K/7, -".2()&/%3 N#" "E1".%+7
#//7&%63
K/%1./:".)&+7;• </.1+7 U()$ 2/. -+%#."+)3
• >.1".&+7 U()$G #7+0- 5> +V".
WX3
7/23/2019 Pancreatic Transplant Tecnique
http://slidepdf.com/reader/full/pancreatic-transplant-tecnique 13/25
12. Cut Portal vein:
Lenght has to be shared for
the liver.
! Landmark before
movilization of the head of
pancreas to avoid short PV
for the pancreas.
13. GIA section 1st portion
of duodenum after Pilorus
and at Treitz.
7/23/2019 Pancreatic Transplant Tecnique
http://slidepdf.com/reader/full/pancreatic-transplant-tecnique 14/25
12. Cut Portal vein:
Lenght has to be shared for
the liver.
! Landmark before
movilization of the head of
pancreas to avoid short PV
for the pancreas.
13. GIA section 1st portion
of duodenum after Pilorus
and at Treitz.
7/23/2019 Pancreatic Transplant Tecnique
http://slidepdf.com/reader/full/pancreatic-transplant-tecnique 15/25
>3 N2 X&:". &) QY! ."1.&":",;
F""- K"7&+# !.(%H +%, 5=> /% +
)&%67" +/.9# -+1#$ -+1#$3
F""- BC>G 7&6+1" $"-+9# +.1".83
B. If Liver is retrieved:
- Section SA at origin
“Dorsal pancreatic artery”
- Ligate GDA
14. Arterial sharing:
7/23/2019 Pancreatic Transplant Tecnique
http://slidepdf.com/reader/full/pancreatic-transplant-tecnique 16/25
>3 N2 X&:". &) QY! ."1.&":",;
F""- K"7&+# !.(%H +%, 5=> /% +
)&%67" +/.9# -+1#$ -+1#$3F""- BC>G 7&6+1" $"-+9# +.1".83
B. If Liver IS retrieved:
- Ligate GDA
- Section SA at origin
“Dorsal pancreatic artery”
7/23/2019 Pancreatic Transplant Tecnique
http://slidepdf.com/reader/full/pancreatic-transplant-tecnique 17/25
>3 N2 X&:". &) QY! ."1.&":",;
F""- K"7&+# !.(%H +%, 5=> /% +
)&%67" +/.9# -+1#$ -+1#$3F""- BC>G 7&6+1" $"-+9# +.1".83
B. If Liver IS retrieved:
- Ligate GDA
- Section SA at origin
“Dorsal pancreatic artery”
7/23/2019 Pancreatic Transplant Tecnique
http://slidepdf.com/reader/full/pancreatic-transplant-tecnique 18/25
RIGHT REPLACED HEPATIC ARTERY:
SMA
GDA
rRHA
Lf RV
IMVcanula
The IPDA comes from SMA
7/23/2019 Pancreatic Transplant Tecnique
http://slidepdf.com/reader/full/pancreatic-transplant-tecnique 19/25
RIGHT REPLACED HEPATIC ARTERY:
SMA
IPDA
rRHA
Lf RV
IPDA comes
from the rRHA
7/23/2019 Pancreatic Transplant Tecnique
http://slidepdf.com/reader/full/pancreatic-transplant-tecnique 20/25
ANASTOMOSIS GDA to stump rRHA
GDA rRHA
SMA
7/23/2019 Pancreatic Transplant Tecnique
http://slidepdf.com/reader/full/pancreatic-transplant-tecnique 21/25
GDA
Y-GRAFT
SMA
SA
7/23/2019 Pancreatic Transplant Tecnique
http://slidepdf.com/reader/full/pancreatic-transplant-tecnique 22/25
KY=<XD!D ID<X>KD=DQ! YZ KDXN>K !I[QF
Ao
SA
SMA
Hep A
GDA
SMA
KEEP Aortic patch with
Celiac Trunk and SMAcut Hepatic A.
7/23/2019 Pancreatic Transplant Tecnique
http://slidepdf.com/reader/full/pancreatic-transplant-tecnique 23/25
KY=<XD!D ID<X>KD=DQ! YZ KDXN>K !I[QF
Ao
SA
SMA
Hep A
GDA
SMA
Section Hep A and SA.
Keep SMA on Aortic
patch
7/23/2019 Pancreatic Transplant Tecnique
http://slidepdf.com/reader/full/pancreatic-transplant-tecnique 24/25
KY=<XD!D ID<X>KD=DQ! YZ KDXN>K !I[QF
Ao
SA
SMA
Hep A
GDA
SMA
7/23/2019 Pancreatic Transplant Tecnique
http://slidepdf.com/reader/full/pancreatic-transplant-tecnique 25/25
FD\ <YNQ!5
!
!+H" + 7+%,0+.H /2 1$" -/.1+7 :"&% ]"2/." ,&)"#9/%
+../(%, $"+, /2 -+%#."+)
!
=&%&0+7 $+%,7&%6 /2 1$" -+%#."+) O$"% 0/:&7&?&%6
!
X//H 2/. ."-7+#", @+##")/.8A I&6$1 J"-+9# > @.IJ>A
–
=+H" )(." 1$" N<C> )1+8) /% 1$" -+%#."+) )&,"
! ^$"% )"#9/%&%6 1$" 5-7"%&# >3
–
H""- 1$" C/.)+7 <+%#."+9# >3 ^&1$ -+%#."+) 6.+V3
Recommended