Clinical Application of Three-dimensional Laparoscopic Artery-first Pancreaticoduodenectomy in Treating Pancreatic Head Malignant Tumors.

Pancreaticoduodenectomy is a technically demanding procedure associated with substantial surgical risk. Conventional laparoscopic approaches have several limitations, including restricted visualization, which can make exposure of the superior mesenteric artery and identification of vessels and lymph nodes challenging. In patients with vascular adhesion or tumor invasion, surgical dissection is particularly difficult and may increase the risk of intraoperative vascular injury and hemorrhage. In addition, poor delineation of anatomical planes may result in incomplete tumor dissection, inadequate lymphadenectomy, and difficult mobilization of the pancreatic head and duodenum, potentially compromising surgical safety and oncological outcomes. To optimize the surgical workflow, this protocol describes a three-dimensional laparoscopic artery-first pancreaticoduodenectomy with the infracolic artery-first approach as the principal technical modification. By combining early arterial exposure and clear delineation of anatomical planes with the stereoscopic visualization of three-dimensional laparoscopy, this technique facilitates identification of vessel-tissue relationships, vascular control, lymphadenectomy, tumor dissection, and tissue mobilization. These features may help reduce inadvertent vascular injury and intraoperative blood loss while enabling complete tumor resection. The protocol provides a standardized surgical approach, particularly applicable to pancreatic head lesions adjacent to or involving major vessels, and is intended to improve the safety and reproducibility of laparoscopic pancreaticoduodenectomy.