Reverse Kocher Maneuver for Robotic Whipple Procedure

We demonstrate our technique for exposing and transecting the jejunum during a robotic Whipple procedure, followed by dissection of the ligament of Treitz and mobilization of the distal duodenum. While this dissection is often approached from the right side of the SMA in the open setting as part of an extended Kocher manuever, we preferentially use this left-sided technique for our robot cases. Operating in the infra-mesocolic area can be challenging and requires optimal utilization of the 4th arm of the robot and patient positioning. After identifying the ligament of Treitz and choosing a site for transection, the vessel sealer is used to open the adjacent mesentery. The bowel is transected and the division of the mesentery proceeds proximally to the ligament of Treitz utilizing the vessel sealer. Small sponges can are used to assist in retraction. Of the several hundred robotic pancreaticoduodenectomies performed at our institution, we have utilized this technique in approximately 75%