The Trunk of Henle and Belcher's Vein: Important Venous Landmarks in Robot-Assisted Pancreatoduodenectomy

Background: The Trunk of Henle and the posterosuperior pancreaticoduodenal vein (Belcher's Vein) are consistent anatomical landmarks of the portomesenteric venous system. Their recognition is particularly relevant in robot-assisted pancreatoduodenectomy (RAPD), where uncinate process dissection from the portal-mesenteric axis represents the most technically demanding step. Methods: We describe a stepwise robotic surgical approach emphasizing the identification, isolation, and safe division of the Trunk of Henle and Belcher's Vein. Intraoperative illustrations are provided to demonstrate the use of these veins as reproducible landmarks during dissection of the pancreatic head and uncinate process. Results: Incorporating these veins as key reference points facilitates precise dissection, improves vascular control, and minimizes intraoperative bleeding. Their consistent anatomical presence allows systematization of the uncinate process approach and reliable exposure of the portal-mesenteric axis. Conclusions: The Trunk of Henle and Belcher's Vein serve as valuable venous landmarks in RAPD. Their routine identification may improve surgical safety, reduce conversion risk, and contribute to a standardized, reproducible methodology for robotic pancreatic head resection.