Superior Mesenteric Artery First Approach for Minimally Invasive Pancreaticoduodenectomy: A Step-By-Step Surgical Technique Video

Introduction. In the past decade, minimally invasive pancreaticoduodenectomy has been gaining interest. However, minimally invasive pancreaticoduodenectomy remains technically challenging and is associated with a steep learning curve. Additionally, the operating surgeon should be cognizant of replicating the same oncological steps as observed in the typical open approach. In view of this, there exist various maneuvers that are designed to achieve negative margins and a safer mesopancreatic dissection. One of these techniques is the superior mesenteric artery first approach, which is garnering interest among pancreatic surgeons. Material and Methods. According to existing literature, there are several superior mesenteric artery dissections approaches. We describes 5 different minimally invasive approaches. Results. This multimedia manuscript provide, for the first time in literature, a comprehensive step-by-step overview of the superior mesenteric artery first approach for minimally invasive pancreaticoduodenectomy by a team of expert surgeons from various international institutions. Conclusions. Through the tips and indications presented in this article, we aim to guide the choice of this approach according to tumor location, type of minimally invasive approach and the operating surgeon's experience and increase familiarity with such a complex procedure.

Automated summary

This article describes the superior mesenteric artery first approach in minimally invasive pancreaticoduodenectomy, including five different minimally invasive approaches. For the first time, a comprehensive step-by-step overview of this approach is provided by a team of expert surgeons from various international institutions. The article aims to guide the choice of approach based on tumor location, type of minimally invasive approach, and the surgeon's experience, and increase familiarity with this complex procedure.