Ex vivo Whipple with small bowel auto-transplant
With sub-total colectomy with SMV and SMA reconstruction
00:05 SURGICAL PLANNING
04:30 Incision & mobilization
07:23 Portal dissection
08:52 Identifying the SMV and its jejunal branches
10:05 Panel graft construction
10:40 Evisceration and specimen retrieval
11:51 Backbench dissection
Case description
- In this video we present a technical challenge that required both surgical oncology and transplantation techniques to overcome. The patient is a 25 year old man with Lynch syndrome who developed an obstructing tumour in the mid-transverse colon. The tumour eroded posteriorly into the pancreas, obliterating the distal SMV and abutting the SMA.
- After a decompressing ileostomy, the patient had multiple courses of chemotherapy with mild response of the primary and no metastases becoming apparent. It was elected to being him to the OR for a subtotal colectomy with whipple, reconstructing the SMV (proximal bifurcation and first jejunal branch) to a panel graft created from the superficial femoral vein.
- The final dissection and venous reconstruction were performed ex vivo after flushing the intestines (small, large) and pancreas head with ice cold preservation solution on the backbench. After re-implantation, the splenic vein was anastomosed to the side of the panel graft in order to avoid splenic congestion.
- The patient did well post-operatively, and was discharged home on post-operative day 10. His 3 month follow up CT shows patent vessels. This case demonstrates the marriage of transplantation techniques to hepatobiliary/surgical oncology procedures.
CT scans (venous phase)
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CT scans (arterial phase)
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