The Knack and Pitfall of the Retropancreatic Nerve Plexus Hanging Maneuver for Pancreatoduodenectomy for Pancreatic Head Carcinoma.

Abstract Background The efficacy of the hanging maneuver for the retropancreatic nerve plexus (RNP) to enhance the confirmation of the margin status and to facilitate en-bloc resection for pancreatoduodenectomy (PD). In this report, we present the knack and pitfall of the hanging maneuver of the RNP. MethodsThe exit of the hanging maneuver of the RNP is the left part of the superior mesenteric artery (SMA), and the entry is the cranial part of the celiac axis. The entry of the hanging maneuver was connected to the dissection line on the right side of the celiac axis. Thereafter, the tape of the hanging maneuver was pulled to the right side, and the RNP was deployed widely. Finally, the RNP was easily dissected using a sealing device other than IPDA ResultsIt is important to clarify the entrance and exit of the hanging taping in this procedure. This permitted the wide spaces between the SMA, SMV, and the resected side, and it was easier to identify the IPDA. By traction of the hanging maneuver tape, a clear line may be drawn between the resection side and the remaining side. ConclusionsWith the correct implementation of the hanging maneuver, we believe that it would be possible to obtain reliable R0 resection as well as a reduction in blood loss and operation time.