The Scopinaro Biliopancreatic Derivation
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Stage 3
The stomach is lifted and the surgeon starts the devascularisation of the greater curvature with the help of the Ultracision _ device. Once the lesser sac has been entered, dissection is continued in a cephalad direction and the lower pole of the spleen is quickly reached.
At the level of the spleen’s lower pole, the peritoneal sheets are farther apart and the tissue in between is thicker and harbours tortuous vessels (the short gastrics) which must be coagulated separately, by using small bites of the Ultracision.
Eventually the dissection reaches the root of the left pillar of the hiatus. Dissection is now taken distally and the duodenum is reached. The duodenum is freed circumferentially and transected by the linear stapler, blue load. After additional hemostasis, while the stomach is lifted anteriorly, the lesser curvature is devascularised until the third transverse vessel is reached, just distal to the fat pad. While the stomach is pulled distally, a tape of 15 cm in length is held against the upper greater curvature and the 15 cm spot is marked by the hook cautery. The stomach is now devided transversally from that spot to the proximally devascularised part of the lesser curvature. The specimen is removed through the left upper quadrant trocar.