Pancreatic exposure

Incision

• Bilateral subcostal or curved transverse incision midway between umbilicus and xiphoid

Whole pancreas

• Requires both mobilisation of the duodenum and entry into the lesser sac
• Kocher's: mobilise the duodenal loop and pancreatic head
• Anterior exposure of the pancreas by entering the lesser sac through the greater or lesser omentum, and take down the congenital adhesions between posterior stomach and pancreas
  • Superior and inferior borders of pancreas can be mobilised by incising the peritoneum overlying them, being aware of major vessels (splenic artery, SMA/SMV, IMV)
• Pancreatic tail: lift stomach upwards, and you may also need to divide some short gastric arteries and attachments of the splenic flexure to get a good look. Mobilising the spleen laterally can allow visualisation of the posterior pancreatic tail