Robotic Pancreaticoduodenectomy with Right Lateral Approach to the Superior Mesenteric Artery: Surgical Artificial Intelligence-Based Visualization for Standardized Dissection.

BACKGROUND

Robotic pancreaticoduodenectomy enables precise vascular dissection, but dissection of the superior mesenteric artery (SMA) remains technically demanding. Ninomiya et al. recently described the right lateral approach (RLA), which provides direct exposure of the SMA from its right side and facilitates systematic dissection (J Hepatobiliary Pancreat Sci. 2023). We adopted this approach and additionally applied surgical artificial intelligence (AI) analysis for postoperative evaluation.

PATIENT AND

METHODS

We present a video case of a 56-year-old woman with pancreatic cancer (T3N1aM0, UICC 8th). After Kocher's maneuver and partial division of the Treitz ligament, the jejunum was mobilized to the right, exposing the SMA laterally. The pancreatic head plexus (PLph I/II) was dissected prior to pancreatic transection. Postoperative surgical AI analysis (Eureka, Anaut Inc., Tokyo, Japan) was applied solely for retrospective evaluation and is currently off-label in pancreatic surgery.

RESULTS

Operative time was 404 min with blood loss of 49 mL. The patient was discharged on postoperative day 7 without complications. Histopathology confirmed R0 resection. The RLA facilitated circumferential exposure of the SMA, improving safety and efficiency of dissection. Postoperative AI analysis automatically visualized neural fibers and connective tissue, objectively confirming outermost layer dissection.

CONCLUSIONS

The RLA represents a safe and effective method for SMA dissection in RPD, consistent with prior reports. Surgical AI-based video analysis enhanced anatomical understanding and validated dissection planes. Future integration of AI into real-time navigation may support standardization of outermost layer dissection and improve reproducibility in robotic pancreatic surgery.