Hanging maneuver during pancreaticoduodenectomy: a technique to improve R0 resection

Dissection of the retroportal lamina from the superior mesenteric artery, whether performed laparoscopically or by open surgery, remains one of the most difficult steps during pancreaticoduodenectomy, and neoplastic invasion of the retroperitoneal margin is associated with a dismal prognosis. Kuroki and colleagues recently described in Surgical Endoscopy a new technique to improve the dissection of retroportal lamina during laparoscopic pancreaticoduodenectomy. In this letter to the editor, the writers underscore their own concept of a "hanging maneuver" to achieve a radical resection for pancreatic malignancies.