{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,13]],"date-time":"2026-02-13T10:35:03Z","timestamp":1770978903395,"version":"3.50.1"},"reference-count":11,"publisher":"MDPI AG","issue":"23","license":[{"start":{"date-parts":[[2022,11,30]],"date-time":"2022-11-30T00:00:00Z","timestamp":1669766400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Japan Society for the Promotion of Science","award":["21K16447"],"award-info":[{"award-number":["21K16447"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>The concept of the superior mesenteric artery (SMA)-first approach has been widely accepted in pancreatoduodenectomy. However, few studies have reported surgical approaches to the SMA in robotic pancreatoduodenectomy (RPD). Herein, we present our surgical strategies to dissect around the SMA in RPD. Among the various approaches, our standard protocol for RPD included the right approach to the SMA, which can result in complete tumor resection in most cases. In patients with malignant diseases requiring lymphadenectomy around the SMA, we developed a novel approach by combining the left and right approaches in RPD. Using this approach, circumferential dissection around the SMA can be achieved through both the left and right sides. This approach can also be helpful in patients with obesity or intra-abdominal adhesions. The present study summarizes the advantages and disadvantages of both the approaches during RPD. To perform RPD safely, surgeons should understand the different surgical approaches and select the best approach or a combination of different approaches, depending on demographic, anatomical, and oncological factors.<\/jats:p>","DOI":"10.3390\/jcm11237112","type":"journal-article","created":{"date-parts":[[2022,11,30]],"date-time":"2022-11-30T07:10:27Z","timestamp":1669792227000},"page":"7112","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["Surgical Strategies to Dissect around the Superior Mesenteric Artery in Robotic Pancreatoduodenectomy"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2267-2441","authenticated-orcid":false,"given":"Kosei","family":"Takagi","sequence":"first","affiliation":[{"name":"Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama 700-8558, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuzo","family":"Umeda","sequence":"additional","affiliation":[{"name":"Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama 700-8558, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ryuichi","family":"Yoshida","sequence":"additional","affiliation":[{"name":"Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama 700-8558, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tomokazu","family":"Fuji","sequence":"additional","affiliation":[{"name":"Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama 700-8558, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kazuya","family":"Yasui","sequence":"additional","affiliation":[{"name":"Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama 700-8558, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jiro","family":"Kimura","sequence":"additional","affiliation":[{"name":"Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama 700-8558, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nanako","family":"Hata","sequence":"additional","affiliation":[{"name":"Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama 700-8558, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kento","family":"Mishima","sequence":"additional","affiliation":[{"name":"Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama 700-8558, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takahito","family":"Yagi","sequence":"additional","affiliation":[{"name":"Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama 700-8558, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5377-6051","authenticated-orcid":false,"given":"Toshiyoshi","family":"Fujiwara","sequence":"additional","affiliation":[{"name":"Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama 700-8558, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,11,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1027","DOI":"10.1002\/bjs.8763","article-title":"\u2018Artery-first\u2019 approaches to pancreatoduodenectomy","volume":"99","author":"Sanjay","year":"2012","journal-title":"Br. J. Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1016\/j.ijsu.2019.11.007","article-title":"Superior mesenteric artery first approach can improve the clinical outcomes of pancreaticoduodenectomy: A meta-analysis","volume":"73","author":"Jiang","year":"2020","journal-title":"Int. J. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1097\/SLA.0000000000003590","article-title":"The Miami International Evidence-based Guidelines on Minimally Invasive Pancreas Resection","volume":"271","author":"Asbun","year":"2020","journal-title":"Ann. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"3","DOI":"10.21037\/cco-21-131","article-title":"Minimally invasive surgery for pancreatic cancer-are we there yet?\u2014A narrative review","volume":"11","author":"Bhandare","year":"2022","journal-title":"Chin. Clin. Oncol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1002\/jhbp.905","article-title":"Surgical approaches to the superior mesenteric artery during minimally invasive pancreaticoduodenectomy: A systematic review","volume":"29","author":"Nagakawa","year":"2022","journal-title":"J. Hepatobiliary Pancreat. Sci."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1004","DOI":"10.1002\/jhbp.1159","article-title":"Prognosis of pancreatic head cancer with different patterns of lymph node metastasis","volume":"29","author":"Min","year":"2022","journal-title":"J. Hepatobiliary Pancreat. Sci."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"4471","DOI":"10.21873\/anticanres.15947","article-title":"Surgical Strategies to Approaching the Splenic Artery in Robotic Distal Pancreatectomy","volume":"42","author":"Takagi","year":"2022","journal-title":"Anticancer Res"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1186\/s12957-021-02167-9","article-title":"Surgical training model and safe implementation of robotic pancreatoduodenectomy in Japan: A technical note","volume":"19","author":"Takagi","year":"2021","journal-title":"World J. Surg. Oncol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e886","DOI":"10.1097\/SLA.0000000000004783","article-title":"Outcomes of a Multicenter Training Program in Robotic Pancreatoduodenectomy (LAELAPS-3)","volume":"276","author":"Zwart","year":"2021","journal-title":"Ann. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"4044","DOI":"10.1007\/s00464-018-6118-z","article-title":"Approaching the superior mesenteric artery from the right side using the proximal-dorsal jejunal vein preisolation method during laparoscopic pancreaticoduodenectomy","volume":"32","author":"Nagakawa","year":"2018","journal-title":"Surg. Endosc."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1373","DOI":"10.1007\/s11605-018-3995-3","article-title":"Optimal Extent of Superior Mesenteric Artery Dissection during Pancreaticoduodenectomy for Pancreatic Cancer: Balancing Surgical and Oncological Safety","volume":"23","author":"Inoue","year":"2019","journal-title":"J. Gastrointest. 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