■ A subcostal incision provides excellent lateral exposure, greatly facilitating access for the dissection.
■ An anterolateral oblique duodenotomy gives ideal exposure, allows further extension if needed, and a two-layer closure does not compromise duodenal lumen.
■ An extended Kocher maneuver is imperative.
■ A folded laparotomy pad placed behind the duodenum displaces the operative field anteriorly.
■ A catheter placed antegrade via the cystic duct provides assurance in locating and protecting the retroduodenal common bile duct, especially when a full thickness excision is performed.
■ Placement of sutures at the margin of the specimen assists exposure and dissection.
■ Optical magnification is very helpful for resection and reconstruction.
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