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| Anatomical features and technical difficulties in laparoscopic pancreaticoduodenectomy with various superior mesenteric artery-first approaches |
| Jie Hua a , b , c , d , Si Shi a , b , c , d , Bo Zhang a , b , c , d , Jin Xu a , b , c , d , Wei Wang a , b , c , d , ∗ |
a Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China
b Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
c Shanghai Pancreatic Cancer Institute, Shanghai 200032, China
d Pancreatic Cancer Institute, Fudan University, Shanghai 200032, China
∗ Corresponding author.
E-mail address: wangwei@fudanpci.org (W. Wang). |
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Abstract Laparoscopic pancreaticoduodenectomy (LPD) at its early stage failed to demonstrate the superiority compared with open pancreaticoduodenectomy (OPD) [1]. The well-known randomized trial, LEOPARD-2, was even terminated due to the safety issue [2], but recent researches [3,4 ] revealed that LPD is technically safe and feasible with acceptable rates of morbidity and mortality and therefore, gains popularity recently. The appropriate surgical approaches are of vital importance for performing LPD safely [5]. Artery-first approach in open operation can be now routinely performed laparoscopically [6]. Ma and coworkers [7] in this issue evaluated the safety and feasibility of LPD with major vascular resection using medial approach compared with those of OPD with major vascular resection. Here, we summarized anatomical features and technical difficulties in LPD with various superior mesenteric artery (SMA)-first approaches. These approaches were classified into four categories according to the direction of access to the SMA (anterior or posterior or left or right).
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2023, Vol. 22 
