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Incising the periduodenal peritoneum
The maneuver starts by incising the periduodenal peritoneum about 1 cm from the lateral duodenal margin. By gently pulling the bowel mediad the assistant puts traction on it. Lift the parietal peritoneum at the level of the mid-duodenum and incise it with scissors. Carry the dissection along the duodenum and posterior to it in the loose layer of the tela subserosa.
Mobilizing the duodenum
Mobilize the duodenum as usual from its lateral aspect. This first exposes the inferior vena cava and allows palpation and visual inspection of the inferior aspect of the pancreatic head and the distal retroduodenal portion of the common bile duct. When it is necessary to reach the space posterior to the head of the pancreas, the dissection may be carried beyond the aorta.
Now the duodenum and pancreatic head can be grasped and moved.