ABSTRACT
Performing a more extensive Kocher maneuver can identify the superior mesen teric vein caudal to the neck of the pancreas. The superior mesenteric vein is identi fied running anterior to the third portion of the duodenum and is frequently surrounded by adipose tissue as it receives tributaries from the uncinate process and neck of the pancreas, the greater curve of the stomach, and from the transverse mesocolon. In this location, the superior mesenteric vein is identified by dissecting the fatty tissue of the transverse mesocolon away from the uncinate process of the pancreas. Division of the branches emptying into the anterior surface of the supe rior mesenteric vein allows continued cephalad dissection. The plane anterior to the superior mesenteric vein is developed under direct vision, avoiding branches and tumor involvement. Care is taken to protect the splenic vein as it joins the superior mesenteric vein posterior to the neck of the pancreas. After the plane anterior to the portal vein and superior mesenteric vein is complete, a Penrose drain is looped under the neck of the pancreas.
