Background : Robotic pancreatoduodenectomy (RPD) is a commonly performed procedure in most centers, but descriptions of RPD involving portal vein (PV) or superior mesenteric vein (SMV) resection and reconstruction are rare. A 56-year-old female patient diagnosed with resectable adenocarcinoma at the head of the pancreas underwent robotic pancreatoduodenectomy. Intraoperatively, it was discovered that the tumor was attached to the SMV. Consequently, SMV resection with type 3 reconstruction was successfully performed.

Methods : In this video, we illustrate the procedural steps of the right posterior superior mesenteric artery (SMA) first approach, followed by superior mesenteric vein (SMV) resection with type 3 reconstruction.

Results : The operative time was 10 hours with an estimated blood loss of 150 ml. SMA & SMV clamping time was 30 minutes and SMV suture took 19 minutes. The patient developed chylous leakage that improved after switching to a low-fat diet. She was discharged on post-operative day 13.

Conclusions : We demonstrated our technique for performing right posterior SMA approach and SMV resection with reconstruction in robotic pancreatoduodenectomy. With advancements in both robotic surgery and surgical techniques, RPD with PV/SMV resection and reconstruction can be performed.