Back to 2025 Abstracts
WHAT IS THE BEST APPROACH FOR ROBOTIC PANCREATICODUODENECTOMY FOR PANCREATIC HEAD CANCER? UTILITY OF LEFT POSTERIOR SMA-FIRST APPROACH
Yosuke Inoue
*, Kosuke Kobayashi, Atsushi Oba, Yoshihiro Ono, Hiromichi Ito, Yu Takahashi
Cancer Institute Hospital, Tokyo, Japan
Background
In recent years, the right anterior approach has become the most widely used technique for robotic pancreaticoduodenectomy (RPD). Based on our experience with laparoscopic pancreaticoduodenectomy (PD), we have introduced the left posterior superior mesenteric artery-first approach (LPAA) for RPD.
Methods
We utilize a scope transition method to optimize visibility during each stage of the RPD. For LPAA, the scope is inserted from the left side of the abdomen (Figure A). Under appropriate retractions, both robotic hands are freed for the dissection of critical vessels. Bipolar dissection is employed to facilitate delicate bloodless dissection. Depending on the tumor extension, we select the dissection level (LV-2 for formal lymph node dissection, LV-3 for periarterial divestment; Figure B). A unique advantage of the LPAA is that it eliminates the need for superior mesenteric vein (SMV) retraction during the superior mesenteric artery (SMA) dissection (Figure C). We reviewed the outcomes of 28 RPD cases for pancreatic head cancers (PC) from a total of 155 RPD cases conducted between 2020 and 2024.
Results
The median blood loss and operation time were 115 ml and 590 minutes, respectively. Two patients required conversion to laparotomy due to bleeding. Four patients underwent portal resection and reconstruction. The incidence of postoperative pancreatic fistula (POPF) (? grade B) and complication rate (Clavien-Dindo ?3a) were both 7% without mortality. The R0 resection rate (according to the 0 mm rule) was 92%.
Conclusions
LPAA was a reasonable and safe approach, particularly when considering the robot-specific settings. This technique enabled early assessment of resectability, control of inflow, and adjustment of dissection levels. We provide detailed technical tips and report the surgical outcomes of our RPD procedures for pancreatic cancers.
Back to 2025 Abstracts
