STEP 2Extended Kocher maneuver

Begin the Kocher maneuver at the transverse portion of the duodenum by dissecting the inferior vena cava (IVC).

Elevate all fibrofatty and lymphatic tissue medial to the right ureter and anterior to the IVC with the specimen (we usually preserve the gonadal vein as it courses anterior to the right ureter because it is a good landmark to avoid inadvertent injury to the right ureter).

Fully mobilize the pancreatic head and duodenum to the cephalad aspect of the left renal vein as it crosses the aorta. The SMA origin can often be exposed at this level by medially rotating the pancreatic head and duodenum and incising the perineural tissue lateral to the first 2 cm of the SMA origin.

STEP 3

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