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Case Reports
. 2024 Dec;31(13):8741-8743.
doi: 10.1245/s10434-024-16305-6. Epub 2024 Sep 27.

Robot-Assisted Pancreaticoduodenectomy Using the Anterior Superior Mesenteric Artery-First Approach for Pancreatic Cancer

Kosei Takagi  1 , Tomokazu Fuji  2 , Kazuya Yasui  2 , Motohiko Yamada  2 , Takeyoshi Nishiyama  2 , Yasuo Nagai  2 , Noriyuki Kanehira  2 , Toshiyoshi Fujiwara  2
Affiliations
Case Reports

Robot-Assisted Pancreaticoduodenectomy Using the Anterior Superior Mesenteric Artery-First Approach for Pancreatic Cancer

Kosei Takagi et al. Ann Surg Oncol. 2024 Dec.

Abstract

Background: The superior mesenteric artery (SMA)-first approach for pancreatic cancer (PC) is common surgical technique in pancreaticoduodenectomy. To date, few studies have reported SMA-first approach in robot-assisted pancreaticoduodenectomy (RPD). Herein, we present the anterior SMA-first approach for PC during RPD.

Patient and method: A 75-year-old man with resectable PC underwent RPD after neoadjuvant chemotherapy. As pancreatic head tumor contacted with the superior mesenteric vein (SMV), the anterior SMA approach was applied. After the mesenteric Kocher maneuver, the jejunum was divided and the left side of the SMA was dissected. Subsequently, the anterior plane of the SMA was dissected. Following the division of branches from the mesenteric vessels, the SMA was taped, and the circumferential dissection around the SMA was performed to detach the pancreatic neck from the SMA completely. Finally, the dissection between the SMV and the tumor was performed under vascular control to remove the specimen.

Conclusions: The anterior SMA-first approach can be optional in patients with PC undergoing RPD. This unique approach allows for the circumferential dissection around the SMA during RPD.

Keywords: Pancreatic cancer; Robotic pancreaticoduodenectomy; Superior mesenteric artery approach.

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Conflict of interest statement

The authors declare that they have no conflict of interest. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Figures

Fig. 1
Fig. 1
Anterior superior mesenteric artery (SMA)-first approach during robotic pancreaticoduodenectomy; A after dissecting the anterior plane of the SMA, the inferior pancreaticoduodenal artery was isolated and divided, B the SMA was encircled and taped, C for vascular control of the portal vein (PV) system, the superior mesenteric vein, PV, splenic vein, and left gastric vein were taped, D, E the resected specimen; SMA superior mesenteric artery, SMV superior mesenteric vein, IPDA inferior pancreaticoduodenal artery, SpV splenic vein, LGV left gastric vein, LRV left renal vein
See this image and copyright information in PMC

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