ArticleSurgical endoscopy2023
Laparoscopic dissection around the superior mesenteric artery by left posterior approach during pancreaticoduodenectomy.
Article in Surgical endoscopy, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers.
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Who cites it
8 citing papers in PubMed, 11 citations in OpenAlex.
- ASO Author Reflections: Which is the Optimal Approach to Uncinate Dissection During Robotic Pancreaticoduodenectomy?Annals of surgical oncology · 2026Article
- ASO Author Reflections: Standardization of the Left Posterior Approach for Robotic Pancreaticoduodenectomy Guided by Anatomical Principles.Annals of surgical oncology · 2026Article
- Mastering Robotic SMA Dissection: How the Correct Anatomical Concept Refines Technical Steps in the Left Posterior Approach.Annals of surgical oncology · 2026Article
- Impact of precise preoperative vascular assessment and different dorsal pancreatic artery variant subtypes on pancreatic surgery-related bleeding.BMC gastroenterology · 2026Article
- Left posterior superior mesenteric artery first approach and circumferential lymphadenectomy with total mesopancreas dissection in laparoscopic pancreaticoduodenectomy.Langenbeck's archives of surgery · 2025Article
- Development of the multiple scope transition method in robotic pancreaticoduodenectomy.Surgical endoscopy · 2024Article
- Robot-Assisted Pancreaticoduodenectomy with Hemicircumferential Dissection of Nerve Plexus Around the Superior Mesenteric Artery.Annals of surgical oncology · 2024Article
- Hepatopancreatoduodenectomy with delayed division of the pancreatic parenchyma when utilizing a right lateral approach to the superior mesenteric artery.Surgical case reports · 2024Article
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Authors and funding
6 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundIn pancreaticoduodenectomy (PD), the approach to superior mesenteric artery (SMA) is a critical process that supports adequate surgical margins and radicality for pancreatic tumors. In most of the reports on laparoscopic PD, the right-sided approach in which the jejunum is pulled out to the right side for peri-SMA dissection is used, since the left side of the SMA is difficult to dissect, and the only way to do this is to dissect the vein first.
methodsWe devised a method to simplify and safely perform peri-SMA dissection by reversing the process, starting from the left side of the SMA. The first step involves the mobilization of the pancreatic head, which allows for rotation around the SMA. The second step involves the dissection of the left side of the SMA and transection of the jejunum. The key point is to change the incision line between the anterior and posterior mesojejunum. The third process includes the inferior pancreatoduodenal artery (IPDA) and first jejunal artery (J1A) dissection, which can be easily performed from the left side because the SMA rotates by simply continuing the dissection along the previously exposed SMA, and the IPDA/J1A are safely dissected at the root because they are drawn to the left side. The remaining processes are performed on the right side.
resultsThis method was performed in 16 cases, and in most cases IPDA/J1A were divided from the left side.
conclusionThe technique for SMA dissection from the left posterior side was described with illustrations and video. Our method allows safe oncologic dissection around SMA avoiding anatomical misorientation during laparoscopic PD.
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