Surgical Strategies to Dissect around the Superior Mesenteric Artery in Robotic Pancreatoduodenectomy

Kosei Takagi, Yuzo Umeda, Ryuichi Yoshida, Tomokazu Fuji, Kazuya Yasui, Jiro Kimura, Nanako Hata, Kento Mishima, Takahito Yagi, Toshiyoshi Fujiwara

Research output: Contribution to journalArticlepeer-review

2 Citations (Scopus)

Abstract

The concept of the superior mesenteric artery (SMA)-first approach has been widely accepted in pancreatoduodenectomy. However, few studies have reported surgical approaches to the SMA in robotic pancreatoduodenectomy (RPD). Herein, we present our surgical strategies to dissect around the SMA in RPD. Among the various approaches, our standard protocol for RPD included the right approach to the SMA, which can result in complete tumor resection in most cases. In patients with malignant diseases requiring lymphadenectomy around the SMA, we developed a novel approach by combining the left and right approaches in RPD. Using this approach, circumferential dissection around the SMA can be achieved through both the left and right sides. This approach can also be helpful in patients with obesity or intra-abdominal adhesions. The present study summarizes the advantages and disadvantages of both the approaches during RPD. To perform RPD safely, surgeons should understand the different surgical approaches and select the best approach or a combination of different approaches, depending on demographic, anatomical, and oncological factors.

Original languageEnglish
Article number7112
JournalJournal of Clinical Medicine
Volume11
Issue number23
DOIs
Publication statusPublished - Dec 2022

Keywords

  • pancreatic cancer
  • pancreatoduodenectomy
  • robotic surgery
  • superior mesenteric artery
  • surgical approach

ASJC Scopus subject areas

  • Medicine(all)

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