The Kocher manoeuvre is a surgical procedure to expose structures in the retroperitoneum behind the duodenum and pancreas. In vascular surgery, it is described as a method to expose the abdominal aorta. It usually has been in contrast to midline laparotomy and right retroperitoneal space dissection. These two procedures have been used for diverse cases, but have approximately equivalent outcomes.
Technique
The Kocher manoeuvre involves the following steps:
- Patient Positioning: The liver is retracted upwards, and the right colic flexure is retracted downwards. The surgeon typically stands on the left side of the patient for better access.
- Duodenal Mobilization: The surgeon rolls the second part of the duodenum, making an incision about 3 cm from the duodenal rim. The duodenum, along with the head of the pancreas, is mobilized, detached from the inferior vena cava and aorta, with the superior mesenteric vessels limiting further mobilization.
Kocher also knew that the duodenum and pancreas are initially hanging freely in the belly, connected by a mesentery. The Kocher maneuver brings these organs back to their original position in the belly.