Anatomical variations of the hepatic artery in duodenopancreatectomy: tips and tricks in the minimally invasive surgical approach.

Anatomical variations of the hepatic artery (HA) are frequent (25-45%), representing a special challenge in minimally invasive surgery. Preoperative knowledge of these variations is essential in pancreaticoduodenectomy (PD) to avoid vascular injury and without compromising mesopancreas resection. Patients with anatomical variants of HA, who underwent PD, were selected including robotic and laparoscopy surgery. In all cases, the "Artery First" approach of the superior mesenteric artery (SMA) was performed allowing the identification of the origin of arterial variants and the gastroduodenal artery to be sectioned. The objective of this multimedia article is to describe the different surgical approaches, including some tips and trick in case of vascular variants.