Techniques

and procurement from deceased

donor. - Surgical anatomy of mul9-organ retrieval:

Pancrea9c retrieval from cadaveric

donor

Pancreas retrieval in mul9-organ donor

Most pancreas donors are also liver donors.
Share portal vein and arterial supply

Triple Arterial vasculariza9on for the pancreas:

Splenic artery (SA)
Gastroduodenal artery (GDA)
Superior mesenteric artery (SMA).

IPDA:
inferior pancreatoduodenal artery
(anterior and posterior arcades)

SMA

SMA

GDA
SPDA:

SA

KEY POINTS
TO REMEMBER

Dorsal Pancreatic Artery.

Inferior Pancreatoduodenal Artery.

1.

2.

Open the lesser sac and

inspect the pancreas:
- Soft,
- no edema,
- no fatty infliltration

Open abdomen cruciate incision.

3.

4.

Identify Common bile

duct and the GDA

5.

Identify with vessel

loop Splenic A.

Open the gastrohepatic

ligament and inspect arterial
anatomy of the liver:
Replacement arteries

6. Extended Kocher manouver, look

for replaced Right Hepa9c
artery (lateral to the CBD).

7. Iden9fy root of the SMA with

vessel loop .

No touch technique to minimize

pancre99s.

8. Movilize spleen medially up to the

spine in the avascular plane
posterior to the pancreas.

6. Extended Kocher manouver, look

for replaced Right Hepa9c
artery (lateral to the CBD).

7. Iden9fy
Identifyroot
rootoof
with
f tthe
he SSMA
MA w
ith
vessel
vessel loop.
loop .

SMA

No touch technique to minimize

pancre99s.
L renal vein

8. Movilize spleen medially up to the

spine in the avascular plane
posterior to the pancreas.

VC

Ao

6. Extended Kocher manouver, look

for replaced Right Hepa9c
artery (lateral to the CBD).

7. Iden9fy root of the SMA with

vessel loop .

No touch technique to minimize

pancre99s.

8. Movilize spleen medially up to the

spine in the avascular plane
posterior to the pancreas.

9. Isolate supraceliac aorta for

clamping. (Thoracic clamping)

10. Cannula9on of the portal vein

through the inferior mesenteric

vein.

11. Cold perfusion. Ice external

cooling.

Controversial:

Portal ush for pancreas.

Arterial ush, clamp SA aVer
1L.

12.

Cut Portal vein:

Lenght has to be shared for
the liver.

Landmark before
movilization of the head of
pancreas to avoid short PV
for the pancreas.

13.

GIA section 1st portion

of duodenum after Pilorus
and at Treitz.

12.

Cut Portal vein:

Lenght has to be shared for
the liver.

Landmark before
movilization of the head of
pancreas to avoid short PV
for the pancreas.

13.

GIA section 1st portion

of duodenum after Pilorus
and at Treitz.

14.

Arterial sharing:

A. If Liver is NOT retrieved:

Keep Celiac Trunk and SMA on a
single aor9c patch patch.
Keep GDA, ligate hepa9c artery.

B. If Liver is retrieved:
- Section SA at origin
Dorsal pancreatic artery
- Ligate GDA

A. If Liver is NOT retrieved:

Keep Celiac Trunk and SMA on a
single aor9c patch patch.
Keep GDA, ligate hepa9c artery.

B. If Liver IS retrieved:
- Ligate GDA
- Section SA at origin
Dorsal pancreatic artery

A. If Liver is NOT retrieved:

Keep Celiac Trunk and SMA on a
single aor9c patch patch.
Keep GDA, ligate hepa9c artery.

B. If Liver IS retrieved:
- Ligate GDA
- Section SA at origin
Dorsal pancreatic artery

RIGHT REPLACED HEPATIC ARTERY:

GDA

IMV
canula

rRHA
SMA

Lf RV

The IPDA comes from SMA

RIGHT REPLACED HEPATIC ARTERY:

IPDA
rRHA

IPDA comes
from the rRHA

SMA

Lf RV

GDA

rRHA

SMA

ANASTOMOSIS GDA to stump rRHA

Y-GRAFT

SMA
SA

GDA

COMPLETE REPLACEMENT OF CELIAC TRUNK

SA
Ao

KEEP Aortic patch with

Celiac Trunk and SMA
cut Hepatic A.

SMA

Hep A
SMA
GDA

COMPLETE REPLACEMENT OF CELIAC TRUNK

SA
Ao

Section Hep A and SA.

Keep SMA on Aortic
patch

SMA

Hep A
SMA
GDA

COMPLETE REPLACEMENT OF CELIAC TRUNK

SA
Ao
SMA

Hep A
SMA
GDA

KEY POINTS
Take a landmark of the portal vein before disec9on
arround head of pancreas
Minimal handling of the pancreas when movilizing
Look for replaced (accesory) Right Hepa9c A (rRHA)
Make sure the IPDA stays on the pancreas side

When sec9oning the Splenic A.

keep the Dorsal Pancrea9c A. With pancreas graV.