A very critical point now involves the identification of the common hepatic artery and the gastroduodenal artery, which runs downward over the pancreas behind the duodenum (Figure 19A). The common hepatic artery may be located by palpation just above the pancreas. The peritoneum over it is carefully incised and this major artery clearly visualized in order to avoid its injury. By blunt dissection, the surrounding tissue is separated until the origin of the gastroduodenal artery is visualized. This vessel must be identified clearly and doubly ligated (Figure 19B). The lumen of the common hepatic artery must not be encroached upon. The tissues about the right gastric artery also must be freed gently and separated upward, as shown by the dotted line (Figure 19B). Following the ligation of these two vessels, blunt dissection with a long right-angle clamp may be undertaken to further free the region of the common duct and portal vein (Figure 20). Since these patients are often rather emaciated, there is relatively little tissue to be separated away from the portal vein. Great care should be taken gently to develop a cleavage plane over the portal vein, which will permit the surgeon to introduce carefully a blunt-nosed clamp, such as a right-angle clamp, behind the pancreas and to open and close the clamp as the tissues are separated from the underlying portal vein. It may be safer and easier for the surgeon to introduce the index finger directly behind the pancreas and over the portal vein. Considerable time should be spent in manipulating the pancreas off the portal vein. This can be done since no vessels enter from the anterior surface of the portal vein. The tissues about the inferior surface of the pancreas may need to be incised so that the finger can be introduced completely underneath the pancreas and come out inferiorly near the region of the middle colic vein (Figure 21).