 Looking at important structural relationships, the pancreas crosses the aorta horizontally and a sandwich between two major arteries. Behind the pancreas head are the common bile duct and the portal vein. Throughout this video, the specimen head is always directed to the left. To extend the viewing field, the left lobe of the liver is cut and removed. After separation from the transverse colon and its mesocolon, the greater momentum is reflected upward. By looking through the cleft of the greater momentum, the pancreas can be viewed behind the omental bursa. Tracing the omental bursa to the left, we reach the pancreas tail and the spleen. Now, behind the pancreas tail, the fusion fascia is stripped. And similarly, the fascia behind the spleen is stripped, and the left half of the pancreas is movable. The right lobe of the liver has been cut to extend the viewing field. The fusion fascia behind the pancreas head and duodenum is stripped. To disconnect the liver from the inferior vena cava, the short hepatic veins and then the typical hepatic veins are cut. The body and tail of the pancreas are supplied by vessels from the splenic artery, which run along the upper margin of the pancreas. Note these major branches and their connections. After removal of the lesser momentum, we trace the major branches of the ciliac trunk. Covered by the large ciliac lymph node, the common hepatic artery continues to the proper hepatic artery, which gives off the right gastric artery. In this specimen, the left gastric artery gives off a left accessory hepatic artery. This artery runs to the portahepatus and forms an arterial circle with the proper hepatic artery. The vagus nerve, which runs along the esophagus, also reaches the liver along this circle. After reflection of the stomach, we see the gastroepiploid arteries. The left artery originates from the splenic artery and the right is from the common hepatic artery via the gastrodoadenal artery. These arteries form an arterial circle at the greater curvature and the upper border of the pancreas. Reflecting the upper margin of the pancreas, we again see the large ciliac node, which extends over both sides of the ciliac trunk, as well as the left gastric vein. Tracing the splenic artery from the origin to the pancreas tail and spleen, we note its characteristic serpentine-like course. Numerous pancreatic branches are found. This artery gives off many branches to the pancreas. Returning to the origin of the splenic artery, we see a descending arterial branch, the dorsal pancreatic artery. Reflecting the pancreas, we see this artery runs behind the pancreas and continues to the lower border of the pancreas. It gives off the inferior pancreatic artery, as well as a branch to the greater omentum. Grasping the origin of the dorsal pancreatic artery and returning the pancreas to the natural position, you can see this artery from the origin of the splenic artery. Tracing this serpentine-like artery, we see it runs within the groove of the pancreas and gives off a thick artery, the great pancreatic artery. Just before the spleen, the splenic artery gives off a branch, which divides into the left gastroepiploid artery and the caudal pancreatic artery. This caudal pancreatic artery continues as the inferior pancreatic artery along the lower border of the pancreas. Reflecting the pancreas, we see this inferior pancreatic artery unites with that from the dorsal pancreatic artery. The arteries of the pancreas head supply both the pancreas and duodenum. The pancreatical duodenal arteries originate from the ciliac trunk and from the superior mesenteric artery. They form pancreatical duodenal arterial arcades in front of and behind the pancreas head, as well as a shortcut pre-pancreatic arcade. In another specimen, the stomach is reflected and the pancreas is median sectioned in order to view the three main branches of the ciliac trunk. Looking now at the splenic artery, left gastric artery and common hepatic artery, note their close proximity. The common hepatic artery divides into two main arteries, the ascending, proper hepatic artery, and the descending gastroduodenal artery. The gastroduodenal artery then divides into the right gastroepiploid artery and the anterior superior pancreatical duodenal artery. Before the gastroduodenal artery bifurcates, it gives off a posterior artery, the superior posterior pancreatic artery, which can be seen by reflecting the pancreas. By tracing this artery behind the pancreas, we reach the posterior inferior pancreatic duodenal artery and then reach its origin at the superior mesenteric artery. This is the posterior pancreatic duodenal arcade. Tracing this arcade, note the closeness to the common bile duct. Returning the pancreas, we trace the superior anterior pancreatic duodenal artery. This interesting arcade, the anterior pancreatic duodenal arcade, runs embedded in the groove between the pancreas and the duodenum. Then we reach the anterior inferior pancreatic duodenal artery and trace to its origin at the superior mesenteric artery. Again reflecting the pancreas, we see this artery originates from the superior mesenteric artery as a short common trunk, together with the posterior inferior pancreatic duodenal artery. Tracing along the anterior surface of the pancreas head, we find another transverse artery which originates from the superior mesenteric artery. It connects with the anterior superior pancreatic duodenal artery to form the pre-pancreatic arcade. The right gastroepiploid vein does not run along the artery. Rather, it descends in front of the pancreas head to reach the superior mesenteric vein. Interestingly, the union of the three major veins, forming the portal vein, occurs immediately behind the pancreas. Here is the right gastroepiploid artery and vein. The right gastroepiploid artery originates from the gastroduodenal artery, which runs along the superior margin of the pancreas head. The right gastroepiploid vein, however, crosses in front of the pancreas head to drain into the superior mesenteric vein. In specimen 3, the pancreas is median sectioned and reflected to view the ciliac trunk and the surrounding vessels. Looking closely at the ciliac trunk, we see the origin of three major arteries, the splenic artery, left gastric artery, and common hepatic artery. Slightly lower to the ciliac trunk, the superior mesenteric artery originates from the abdominal aorta. We can see the relationship of the portal vein to these vessels. Note that the splenic vein is sandwiched between the ciliac trunk and the superior mesenteric artery. In this specimen, the inferior mesenteric vein drains into the superior mesenteric vein rather than into the splenic vein. Also interesting in this specimen, a supernumerary artery originates from the ciliac trunk and crosses obliquely behind the portal vein to reach the liver. This is termed a right accessory hepatic artery. This concludes the demonstration of the blood vessels of the pancreas. Here, with the specimen head to the left, the diaphragm has been removed and the liver partially removed to view the lesser curvature of the stomach. Looking closely, we find the left gastric artery and its corresponding vein. Tracing toward the artery's origin, we reach the point of trifurcation of the ciliac trunk. Close to the angle between the left gastric and common hepatic arteries, we find a large ciliac lymph node. From the portahepatus, numerous lymph vessels run along the proper and common hepatic arteries to drain into this large ciliac node. By reflecting the pancreas body and tail, we find the splenic artery and observe the posterior surface of the pancreas. Tracing to the origin of the splenic artery, we see the trifurcation of the ciliac trunk. Lymphatics from the upper abdominal organs run along these arteries and converge at this large node located at the trifurcation point of the ciliac trunk. Reflecting the pancreas, stomach, and spleen, we look carefully at the lymphatics along the splenic artery. Note the lymphatics from the posterior surface of the stomach near the cartia. You can clearly see the distal portion of the splenic artery between the spleen, pancreas, and fondus of the stomach. By shifting the artery, we are responding vein. Here are two pancreatical splenic nodes. Interestingly, the lymphatics along this artery receive lymph from both sides, from the lymphatics of the stomach and pancreas, and also from the spleen. Looking now at the greater curvature of the stomach, we will examine the lymphatics along the right gastroepiploic artery. Tracing along the lymphatics to the right, we see several right gastroepiploic nodes. We then reach a pyloric node. Reflecting the stomach upward, we see the pyloric nodes and the continuation of lymph vessels to the anterior surface of the pancreas. These vessels then descend to reach the superior mesenteric artery and vein. Now tracing the lymphatics along the anterior pancreatical duodenal arcade, we reach those along the anterior inferior pancreatical duodenal artery. These lymphatics converge to reach the nodes of the superior mesenteric artery. Likewise, lymphatics from the ansone process reach the nodes of the superior mesenteric artery. Lymphatics from the duodenum also reach this area. Looking closely at the initial part of the jejunum, we find numerous lymph vessels which reach nodes along the proximal part of the superior mesenteric artery. In fact, these nodes are critical conglomerate nodes receiving lymph from the pancreas, duodenum, and also the first part of the jejunum. By cutting the origin of the ciliac trunk and the superior mesenteric artery at the aorta, we see lymphatics of the posterior surface of the pancreas and hepatic pedicle. Large lymph nodes at the upper margin of the pancreas head, where it meets the portal vein, receive lymph from the hepatic pedicle as well as from along the pancreatical duodenal arcade. Looking at the posterior surface of the duodenum, pancreas head, and hepatic pedicle from the right, we see the upper angle of the inferior vena cava and the left renal vein close to the aorta. Here, we see a large node along the hepatic pedicle and near the upper margin of the pancreas head. Looking at the numerous lymph vessels which this node receives, we see vessels along the gallbladder and cystic duct. In fact, vessels from both the posterior and anterior surface of the hepatic pedicle reach this node. These important nodes were termed by Ruvier as the superior retro-pancreatical duodenal nodes. Numerous small lymph nodes form the posterior pancreatical duodenal chains, and lymphatics from these nodes run on the posterior surface of the pancreas head. Some run directly, and others run via the above-mentioned large node to reach the critical convergence area, the upper angle between the inferior vena cava and left renal vein. Here, the inferior vena cava has been cut at the level slightly above the left renal vein. We follow the former mentioned lymphatics and find that some reach the interaortic cable nodes just above the left renal vein, and some descend in front of the left renal vein to converge at the interaortic cable nodes just below the left renal vein. This scheme from the Japanese Society for Gastric Cancer Research clearly outlines the critical pera-aortic nodes with special reference to those just above and below the left renal vein. In another specimen with the ciliac trunk and superior mesentery artery cut, the pera-aortic lymphatics are clearly dissected. As discussed earlier, lymphatics from the hepatic pedicle, duodenum, and pancreas head all converge near the upper angle of the inferior vena cava and left renal vein at the interaortic cable nodes. These nodes lie both above and below the left renal vein, with numerous connecting vessels between them. To the left of the aorta, the lateral aortic nodes lie both above and below the left renal vein. Now we will focus on the autonomic nerves. Returning to the first specimen, in order to view the right ciliac plexus, the lymphatics which lie superficial to it must be removed. We will examine the sympathetic and parasympathetic components of the right ciliac ganglion. As we clear away lymphatics, we also clear the connective tissues which contain the autonomic nerves. To the right of the ganglion, the right adrenal gland can be seen. The short supra-renal vein to the inferior vena cava is cut in order to move the gland. After reflection of the diaphragm, in the thorax, we find the greater splanchnic nerve which originates from the thoraxic sympathetic trunk and trace downwards. We follow the greater splanchnic nerve through the diaphragm. Now we will cut the right cruise of the diaphragm. Here we note the inferior phrenic artery and its branches, the superior supra-renal arteries, which we will cut to reflect the adrenal gland. With the diaphragm cut and removed, we are able to reach the ciliac trunk. The greater splanchnic nerve reaches the ciliac ganglion. The parasympathetic component, the posterior vagus, also reaches the right ciliac ganglion. Branches from the ciliac ganglion reach the liver, bile duct, and pancreas. We see the ciliac trunk and superior mesentery artery, arching between these two arteries is the posterior pancreatical duodenal arcade. Here we find branches to the hepatic pedicle. These branches run along the right accessory hepatic artery which runs behind the portal vein. These are autonomic nerves to the gallbladder and bile duct. Here are the components which form the right ciliac ganglion with sympathetic yellow and parasympathetic green. The pancreas head is situated immediately in front of the right ciliac ganglion and thus it easily receives nerves from this ganglion. In a transverse section view, note the close relationship of the pancreas head and the ciliac ganglion. Lymphatics and autonomic nerves are intermingled in the narrow space between the pancreas head, inferior vena cava, and abdominal aorta. Returning to the specimen with the lymphatics removed, we will examine the branches of the right ciliac plexus You can see that numerous branches directly reach the posterior surface of the pancreas head. In addition, branches run along the superior mesentery artery and the posterior inferior pancreatical duodenal artery to reach the inferior part of the pancreas head. Due to the close proximity of the pancreas head and these major plexuses, these nerves are short and are tightly intermingled with the lymphatics. Now we will look at the composition of the left ciliac ganglion formed by the union of the left greater splenchnic nerve and posterior vagus. Also we will note the relationship to the pancreas body and tail. In specimen 3, the median part of the pancreas has been sectioned. We reflect the pancreas body to the right to view its posterior surface. Tracing the posterior vagus along the esophagus, we reach the left ciliac ganglion. The other component of this ganglion is the left greater splenchnic nerve seen here. Tracing now the nerves from the left ciliac ganglion, we see that the nerves which run along both sides of the splennic artery reach the spleen. The lower nerve in this specimen runs along the upper margin of the pancreas body and tail and gives off numerous twigs. Note that fewer nerves reach the pancreas body and tail than the pancreas head. In the branches of the right ciliac ganglion, we note its main components forming the ciliac ganglion loop. Reflecting the adrenal gland, we see that the right greater splenchnic nerve and posterior vagus unite to form the right ciliac ganglion. Now we will remove the superior mesenteric plexus and cut the suprarino branches to free the right ciliac ganglion loop. The pancreatic duct runs within the pancreas tail and body and divides into two within the pancreas head. The lower, main pancreatic duct opens into the descending portion of the duodenum together with the common bile duct. The upper or accessory pancreatic duct opens slightly superior to the main pancreatic duct. In the specimen, the descending portion of the duodenum is opened in order to locate the duodenal papillae. Two papillae are found. The lower, the major papilla, and the upper, the minor papilla. In the major papillae, there are two openings at its summit, one being that of the pancreatic duct and the other, the opening of the common bile duct. The minor papilla appears to be that of the accessory pancreatic duct. Returning the duodenal wall, we trace the accessory pancreatic duct back to the enciné process. Then we pull the duct to confirm that its opening is the minor papillae. Now let's look at the major duodenal papilla. First, by reflecting the duodenum and pancreas head, and by cutting the duodenal wall, we locate the common bile duct and main pancreatic duct. We observe that these two ducts open together at the major papilla. Returning to the anterior surface, we will again trace the accessory pancreatic duct which lies superior and anterior to the main duct in this specimen. We see that it bends as it descends to connect with the main pancreatic duct. Again, from behind, you can clearly see the connection of the two ducts. In specimen 2, we injected silicone into the ducts at the papillae and removed the pancreatic tissues along the whole length of the pancreas to observe the course of the duct. Numerous small ducts open into the main duct. The main duct bends at almost the right angle at the border between the body and then descends. The main duct opens into the descending portion of the duodenum at the major papilla. This papilla was cut for the silicone injection. Thus, it cannot be seen. By reflecting the superior mesenteric vein and then the superior mesenteric artery, we observe the ansone process. From the anterior part of the ansone process, small ducts open into the accessory pancreatic duct and anterior to the main duct. In this specimen, the accessory duct opens into the upper part of the descending portion of the duodenum. As we observe from the front, now let us flip it over to see the pancreas head and ansone process from behind. We can see that numerous small ducts from the head and ansone process open into the main pancreatic duct as it lies posterior to the accessory duct. Interestingly, the small ducts converge to open together into the main duct. The courses of the pancreatic ducts and their openings have been demonstrated.