Step by step pancreatic cancer surgery I Whipple procedure I Pancreaticoduodenectomy

This video on step by step pancreatic cancer surgery focuses on a Whipple procedure or a classical pancreaticoduodenectomy and elaborates on the Modified Blumgart technique of pancreaticojejunostomy. A lot of patients also ask what is the Whipple procedure? – This is one of the standard surgery for pancreatic cancer at the head of the pancreas as well as for periampullary cancer.

This Surgery has been performed by Dr. Prasad Wagle, senior consultant hepatobiliary and pancreatic surgeon (Liver surgeon in Mumbai, Pancreatic Surgeon in Mumbai) at Lilavati hospital, as well as ACI Cumbala Hill Hospital, Mumbai, Maharashtra, India.

The patient had a resectable periampullary mass with elevated Ca 19.9 and bilirubin levels of 5/4.5. He had no other comorbidities except  hypothyroidism. No preoperative biliary drainage was performed.

Whipple procedure for pancreatic cancer begins with appropriate preoperative planning and then execution during surgery. This patient had a replaced right hepatic artery and this was known preoperatively. The key steps as shown in the video include.

  • Assessment for metastatic disease.
  • Kocherization
  • Creation of superior and inferior retropancreatic tunnel
  • Identification of gastroduodenal artery, its clamp test, and then ligation leaving a stump
  • Stepwise uncinate dissection at different parts of the Whipple procedure
  • Anastomosis by Modified Blumgart technique for pancreaticojejunostomy and single-layer interrupted hepaticojejunostomy.

Then, a stapled retrogastric antecolic gastrojejunostomy was performed followed by drain placement and closure.

Histopathologically, the tumor was well-differentiated adeno carcinoma with all margins free and all nodes/12 negative. The patient was discharged on the 7th day on normal diet uneventfully. So, let us enjoy the video !!!