OR / Prep · Hepatobiliary Surgery · open
You’re scrubbing into
Pancreaticoduodenectomy (Whipple)
Why are we operating?
The biggest scheduled operation in general surgery: resection of the pancreatic head and everything plumbed into it, then three anastomoses to put the plumbing back.
Indication: Resectable malignancy of the pancreatic head, ampulla, distal bile duct or duodenum.
The operation in 4 steps
01Assessing resectability
02Kocherisation and dissection
03The resection
04Reconstruction
Danger zones
Common bile duct
The structure every biliary operation is designed not to injure; misidentification is the field's defining catastrophe.
Right hepatic artery
Crosses the triangle aberrantly in about one in seven patients, hugging the cystic duct.
Duct of Luschka
A small subvesical duct in the liver bed; missed, it declares itself as a postoperative bile leak.
Watch it done
The Whipple procedure
What is removed, what is reconnected, and why the three anastomoses matter.
Source: Johns Hopkins Medicine · Watch on YouTubePancreatic anatomy and the Whipple operation
The anatomy lecture that makes the operation make sense: SMV, portal vein and the uncinate.
Source: Medical College of Wisconsin · Watch on YouTube
Conceptual teaching for learners preparing to observe and assist under supervision, not operative instructions. Five minutes from now you should know why this operation exists, what its shape is, and which structures it is designed not to injure.