Related Experiment Video
Updated: Oct 13, 2025
Robotic Pancreatoduodenectomy for Pancreatic Head Cancer: a Case Report of a Standardized Technique
Published on: June 24, 2022
International expert consensus on precision anatomy for minimally invasive pancreatoduodenectomy: PAM-HBP surgery
Yuichi Nagakawa1, Kohei Nakata2, Hitoe Nishino1,3
1Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Tokyo, Japan.
Background:
The anatomical structure around the pancreatic head is very complex and it is important to understand its precise anatomy and corresponding anatomical approach to safely perform minimally invasive pancreatoduodenectomy (MIPD). This consensus statement aimed to develop recommendations for elucidating the anatomy and surgical approaches to MIPD.
Methods:
Studies identified via a comprehensive literature search were classified using the Scottish Intercollegiate Guidelines Network method. Delphi voting was conducted after experts had drafted recommendations, with a goal of obtaining >75% consensus. Experts discussed the revised recommendations with the validation committee and an international audience of 384 attendees. Finalized recommendations were made after a second round of online Delphi voting.
Results:
Three clinical questions were addressed, providing six recommendations. All recommendations reached at least a consensus of 75%. Preoperatively evaluating the presence of anatomical variations and superior mesenteric artery (SMA) and superior mesenteric vein (SMV) branching patterns was recommended. Moreover, it was recommended to fully understand the anatomical approach to SMA and intraoperatively confirm the SMA course based on each anatomical landmark before initiating dissection.
Conclusions:
MIPD experts suggest that surgical trainees perform resection based on precise anatomical landmarks for safe and reliable MIPD.
