{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T00:15:26Z","timestamp":1789431326291,"version":"build-2803163510"},"reference-count":31,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2025,2,21]],"date-time":"2025-02-21T00:00:00Z","timestamp":1740096000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Hepato Biliary Pancreat"],"published-print":{"date-parts":[[2025,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>A complete dissection around the superior mesenteric artery (SMA) with artery\u2010first concept is crucial during pancreaticoduodenectomy for periampullary cancers. The left\u2010posterior (LP) approach to the SMA may be effective during robot\u2010assisted pancreaticoduodenectomy (RPD), but data on its technical feasibility and clinical outcomes are limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We retrospectively reviewed 83 RPD patients utilizing the LP approach, dividing them into early (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200942) and late (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200941) groups to assess procedural maturity. The LP approach was initiated at the first phase of resection to achieve circumferential SMA dissection from the left and posterior aspect and early vascular control through ligation of the inferior pancreaticoduodenal artery (IPDA). Postoperative short\u2010term outcomes were compared between the two groups.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The late group demonstrated significantly shorter operative times (518 vs. 626\u2009min;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u2009.01) and higher rates of IPDA ligation (90% vs. 71%;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u2009.03). The median blood loss in the late group was 50\u2009mL (65\u2009mL in the early group;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u2009.39). Lymph node retrieval number was 17 in both (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u2009.81), and R0 resection was achieved in all late group cases (96% in the early group;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u2009.35).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>With experience from approximately 80 cases, the LP approach for RPD has enabled precise SMA dissection and early vascular control. A stable and super\u2010magnified caudal view provided by robotic surgery is particularly advantageous for this approach.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jhbp.12120","type":"journal-article","created":{"date-parts":[[2025,2,21]],"date-time":"2025-02-21T07:06:38Z","timestamp":1740121598000},"page":"317-326","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["A left\u2010posterior approach to the superior mesenteric artery during robot\u2010assisted pancreaticoduodenectomy"],"prefix":"10.1002","volume":"32","author":[{"given":"Sho","family":"Kiritani","sequence":"first","affiliation":[{"name":"Division of Hepatobiliary and Pancreatic Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5812-6608","authenticated-orcid":false,"given":"Yosuke","family":"Inoue","sequence":"additional","affiliation":[{"name":"Division of Hepatobiliary and Pancreatic Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takafumi","family":"Sato","sequence":"additional","affiliation":[{"name":"Division of Hepatobiliary and Pancreatic Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yui","family":"Sawa","sequence":"additional","affiliation":[{"name":"Division of Hepatobiliary and Pancreatic Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research  Tokyo 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Hospital of the Japanese Foundation for Cancer Research  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiromichi","family":"Ito","sequence":"additional","affiliation":[{"name":"Division of Hepatobiliary and Pancreatic Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3066-023X","authenticated-orcid":false,"given":"Yu","family":"Takahashi","sequence":"additional","affiliation":[{"name":"Division of Hepatobiliary and Pancreatic Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research  Tokyo 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