Skip to main content
SpringerLink
Log in

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

  • Pancreatic Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Nagakawa Y, Watanabe Y, Kozono S, Boggi U, Palanivelu C, Liu R, et al. Surgical approaches to the superior mesenteric artery during minimally invasive pancreaticoduodenectomy: a systematic review. J Hepatobiliary Pancreat Sci. 2022;29(1):114–23.

    Article  Google Scholar 

  2. Ielpo B, Sanchez P, Grande L, Burdio F. Laparoscopic pancreatoduodenectomy: how we have standardized the technique (with video). Updates Surg. 2022;74(4):1479–1481.

    Article  Google Scholar 

  3. Kendrick ML, Cusati D. Total laparoscopic pancreaticoduodenectomy: feasibility and outcome in an early experience. Arch Surg. 2010;145(1):19–23.

    Article  Google Scholar 

  4. Asbun HJ, Stauffer JA. Laparoscopic vs open pancreaticoduodenectomy: overall outcomes and severity of complications using the Accordion Severity Grading System. J Am Coll Surg. 2012;215(6):810–9.

    Article  Google Scholar 

  5. Fuks D. Minimally invasive pancreatoduodenectomy. Br J Surg. 2020;107(6):630–1.

    Article  CAS  Google Scholar 

  6. Tan CL, Zhang H, Peng B, Li KZ. Outcome and costs of laparoscopic pancreaticoduodenectomy during the initial learning curve vs laparotomy. World J Gastroenterol. 2015;21(17):5311–9.

    Article  Google Scholar 

  7. Wang M, Meng L, Cai Y, Li Y, Wang X, Zhang Z, et al. Learning curve for laparoscopic pancreaticoduodenectomy: a CUSUM analysis. J Gastrointest Surg. 2016;20(5):924–35.

    Article  Google Scholar 

  8. Nagakawa Y, Nakamura Y, Honda G, Gotoh Y, Ohtsuka T, Ban D, et al. Learning curve and surgical factors influencing the surgical outcomes during the initial experience with laparoscopic pancreaticoduodenectomy. J Hepatobiliary Pancreat Sci. 2018;25(11):498–507.

    Article  Google Scholar 

  9. Shi Y, Wang W, Qiu W, Zhao S, Wang J, Weng Y, et al. Learning curve from 450 cases of robot-assisted pancreaticoduocectomy in a high-volume pancreatic center: optimization of operative procedure and a retrospective study. Ann Surg. 2021;274(6):e1277–83.

    Article  Google Scholar 

  10. Zhang T, Zhao ZM, Gao YX, Lau WY, Liu R. The learning curve for a surgeon in robot-assisted laparoscopic pancreaticoduodenectomy: a retrospective study in a high-volume pancreatic center. Surg Endosc. 2019;33(9):2927–33.

    Article  Google Scholar 

  11. Pessaux P, Varma D, Arnaud JP. Pancreaticoduodenectomy: superior mesenteric artery first approach. J Gastrointest Surg. 2006;10(4):607–11.

    Article  Google Scholar 

  12. Vasiliadis KD. “Mesopancreas-first” radical resection of pancreatic head cancer following the Cattell-Braasch-Valdoni maneuver: appreciating the legacy of pioneers in visceral surgery. Ann Hepatobiliary Pancreat Surg. 2021;25(3):376–85.

    Article  Google Scholar 

  13. Sanjay P, Takaori K, Govil S, Shrikhande SV, Windsor JA. “Artery-first” approaches to pancreatoduodenectomy. Br J Surg. 2012;99(8):1027–35.

    Article  CAS  Google Scholar 

Download references

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Hepatobiliary and Pancreatic Surgery Unit, Hospital del Mar. Hospital del Mar Medical Research Institute (IMIM), Universitat Pompeu Fabra, Barcelona, Spain

    Benedetto Ielpo MD, PhD, FEBS, FACS, Fernando Burdio MD, PhD & Patricia Sanchez-Velazquez MD, PhD, FEBS

  2. HPB and Transplant Surgery Unit, Department of Surgery, Policlinico Tor Vergata, Rome, Italy

    Alessandro Anselmo MD, PhD, FEBS

  3. Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore

    Yoshio Masuda MD & Mark Yeo Hao Xuan MD

  4. Service de Chirurgie Générale et Mini-Invasive ( Lapariscopie et Robotique), Centre Hospitalier de Luxembourg, Luxembourg City, Luxembourg

    Vito De Blasi MD, PhD, Juan Santiago Azagra MD, PhD & Edoardo Rosso MD, PhD

  5. Unit of General and Emergency Surgery, San Carlo Hospital, Potenza, Italy

    Antonio Giuliani MD, PhD

  6. Chirurgia Generale Azienda Ospedaliera Card.G.Panico, Tricase, Italy

    Giuseppe Massimiliano Viola MD, PhD

  7. Department of Surgical Science, University of Cagliari, Cagliari, Italy

    Mauro Podda MD, PhD, FACS

  8. Colorectal Surgery, Vall d’Hebron University Hospital, Barcelona, Spain

    Gianluca Pellino MD, PhD, FRCS, FRCP, FEBS, FASCRS, FACS

  9. Department of Advanced Medical and Surgical Sciences, Università Degli Studi Della Campania “Luigi Vanvitelli”, Naples, Italy

    Gianluca Pellino MD, PhD, FRCS, FRCP, FEBS, FASCRS, FACS

Authors
  1. Benedetto Ielpo MD, PhD, FEBS, FACS
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Alessandro Anselmo MD, PhD, FEBS
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yoshio Masuda MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mark Yeo Hao Xuan MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Fernando Burdio MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Vito De Blasi MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Patricia Sanchez-Velazquez MD, PhD, FEBS
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Antonio Giuliani MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Juan Santiago Azagra MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Giuseppe Massimiliano Viola MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Mauro Podda MD, PhD, FACS
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Gianluca Pellino MD, PhD, FRCS, FRCP, FEBS, FASCRS, FACS
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Edoardo Rosso MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Benedetto Ielpo MD, PhD, FEBS, FACS.

Ethics declarations

Disclosure

All authors declare there are no competing interests to declare.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (MP4 298559 kb)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ielpo, B., Anselmo, A., Masuda, Y. et al. Superior Mesenteric Artery First Approach for Minimally Invasive Pancreaticoduodenectomy: A Step-By-Step Surgical Technique Video. Ann Surg Oncol 30, 1500–1503 (2023). https://doi.org/10.1245/s10434-022-12743-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-022-12743-2

Search

Navigation