STEP 3Lymphadenectomy transection of the duodenum

Dissection of the surrounding lymph nodes is performed. For better exposure of these nodes the stomach is held upwards by ventral traction. The lymph nodes at the upper margin of the pancreas are dissected towards the duodenum to facilitate the later en-bloc resection. Injury of the serosa of the duodenum and of the capsula of the pancreas has to be avoided.

The lymphadenectomy of the hepatoduodenal ligament is performed. In addition, the lymph nodes around the origin of the right gastric artery are dissected towards the stomach. The right gastric artery is then ligated at its origin. After circular dissection of the gastroduodenal junction the duodenum is transected 1-2cm behind the pylorus with a linear stapler device and the stapler suture line is inverted with single sutures (see chapter "Total Gastrectomy with Conventional Lymphadenectomy," STEP 5).

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