The next maneuver involves an extended Kocher maneuver by mobilizing the entire right colon and the proximal as well as the distal duodenum; this allows palpation of the head of the pancreas and, equally important, the wall of the duodenum.
Intraoperative ultrasonography is performed in a systematic fashion with a near-field, high-resolution transducer. Small neoplasms within the pancreas are identified by their sonolucent nature compared to the more echo-dense pancreas. Although intraoperative ultrasonography of the duodenum is also performed, duodenal gastrinomas, if small, are often missed by this procedure.
Finally, the liver is also evaluated for metastases.
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For centuries, ever since the legendary Ponce de Leon went searching for the elusive Fountain of Youth, people have been looking for ways to slow down the aging process. Medical science has made great strides in keeping people alive longer by preventing and curing disease, and helping people to live healthier lives. Average life expectancy keeps increasing, and most of us can look forward to the chance to live much longer lives than our ancestors.