After instillation of a betadine solution through a gastric tube, the duodenum and the jejunum are stapled distal to the pylorus and the ligament of Treitz, respectively. The mesenteric root is transected distally of the pancreas using the GIA stapling device. The splenocolic ligament is taken down and the spleen and the pancreas are freed retroperitoneally. Finally, the IVC is transected at the level of the right adrenal gland, the liver is mobilized by transection of the falciform ligament and the liver-pancreas bloc is removed containing a large diaphragmatic patch.
The ex-vivo separation of liver and pancreas is done on the back-table after identification of the vascular anatomy (see back-table work).
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