Pancreatic Surgery at Hospital San Juan de Dios, Seville

Clinical Case

The patient, a 63-year-old male, was diagnosed by CT scan and magnetic resonance imaging (MRI) with a neoplasm located in the head of the pancreas. Several challenges were identified during preoperative assessment:

• • The presence of an anatomical variant, in which the right hepatic artery originated exclusively from the superior mesenteric artery
  • The tumour was located in close proximity to this artery, significantly increasing surgical complexity
  • Inflammatory changes were observed near the right hepatic artery, secondary to a fine-needle aspiration biopsy (FNAB)

3D Surgical Planning

As demonstrated by conventional imaging, an inflammatory process was present adjacent to the tumour. The 3D model proved essential in differentiating the tumour from the inflammatory tissue and in accurately visualising their respective relationships with surrounding structures, including vascular anatomy, pancreatic morphology and the biliary tree.

This comprehensive analysis significantly enhanced understanding of the case and supported safer, more precise surgical planning.

Surgical Outcome

In the operating theatre, the surgical team performed a pancreaticoduodenectomy (Whipple procedure), preserving the right hepatic artery arising from the superior mesenteric artery. In addition, a standard lymphadenectomy and Roux-en-Y reconstruction were carried out.

The total operative time was 235 minutes. The procedure was led by Dr Miguel Ángel Gómez Bravo, Consultant HPB Surgeon at Hospital San Juan de Dios, Seville, with the collaboration of Dr José Tinoco González, Dr Hinojosa, and Dr Rosa Jiménez, all Consultants in General and Digestive Surgery with extensive experience in complex pancreatic surgery.