STEP 5Preparation and procurement of the arterial axis

Once the abdominal organs are discolored and the thoracic procurement is completed, the en-bloc liver-pancreas procurement can start. The dissection of the superior mesenteric artery trunk is completed at the anterior side of the abdominal aorta. Retroperitoneal tissue and solar plexus located between IVC and aorta are transected from the left renal vein towards Winslow's foramen in order to fully expose the right side of the aorta and the superior mesenteric artery. Next, the anterior side of the aorta is incised just distally to the origin of the superior mesenteric artery. After visualization of the orifices of the renal arteries, an arterial aortic Carrel patch encompassing the origin of both superior mesenteric artery and celiac trunk is created. The simultaneous excision of the vascular roots of the tissue bloc is an important step of the en-bloc liver-pancreas procurement.

Afterwards, colon and intestine are repositioned in the abdomen. All branches of the left gastric artery are transected closed to the stomach, allowing the preservation of a possible left hepatic artery (LHA) originating from the left gastric artery.

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