D-2

Kocherization 1

Assistant’s hands holding Assistant’s hands holding the duodenumthe duodenum

Inf. vena cavaInf. vena cava Transv. colonTransv. colon

22ndnd part of the part of the duodenumduodenum

HeadHead

Kocherization 2

Kocherization 3

Inf. vena cavaInf. vena cavaTransv. colonTransv. colon

AortaAorta

Lt. renal V.Lt. renal V.

Rt. kidneyRt. kidney

Bursectomy

OmentumOmentum

DuodenumDuodenum

Ant. sheet of transv. mesocolonAnt. sheet of transv. mesocolon

Post. sheet of transv. mesocolonPost. sheet of transv. mesocolon

Completion of Bursectomy

Pancreatic tailPancreatic tail

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

Division of the Right Gastro-epiploic Vein

Exposure of the Supra-pyloric Area

Rt. gastric A.Rt. gastric A.

Sup. duodenal A.Sup. duodenal A.

PylorusPylorus

Exposure of the Right Gastric Argery

Gastroduodenal A.Gastroduodenal A.

Rt. gastric A.Rt. gastric A.

Transection of the Duodenum

Dissection of the Upper Border of the Pancreas

Identification of the Splenic Artery

Splenic A.Splenic A.

Gastroduodenal A.Gastroduodenal A.

No. 8a LNNo. 8a LN

Common hepatic A.Common hepatic A.

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.

Taping of the Common Hepatic Artery

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.

Ligation of the Splenic Artery

Division of the Left Gastric Artery

Lt. gastric A. stumpLt. gastric A. stump

Exposure of the Esophageal Hiatus

Diaphragmatic crusDiaphragmatic crus

Post. wall of the cardiaPost. wall of the cardiaPost. vagal trunkPost. vagal trunk

Exposure of the Abdominal Esophagus

Transection of the Esophagus

Mobilization of the Pancreas 1

Pancreatic bodyPancreatic bodySpleenSpleen

Lt. adrenalLt. adrenal

Mobilization of the Pancreas 2

Pancreatic tailPancreatic tailSpleenSpleen

Lt. kidneyLt. kidney

Mobilization of the Spleen

SpleenSpleen

Completion of Mobilization

SpleenSpleenStomachStomach

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

Distal Pancreatectomy

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

Esophago-jejunostomy 1

Esophago-jejunostomy 2

Closure of the Jejunal Stump

EsophagojejunostomyEsophagojejunostomy

Jejuno-jejunostomy

Completion of Roux-en-Y Reconstruction

Jejuno-jejunostomyJejuno-jejunostomy

Closure of the Mesenteric Defect