Background: Pancreaticoduodenectomy is a standard treatment for periampullary carcinoma. Currently, morbidity of this surgery is still high. Even though laparoscopic pancreaticoduodenectomy was successfully done more than 20 years ago, the adoption of this minimally invasive surgery is very slow. Recent development of superior mesenteric artery first pancreaticoduodenectomy increased the complexity of the procedure. The technique of laparoscopic left posterior superior mesenteric artery first pancreaticoduodenectomy was successfully developed in our center in 2013.

Objective: To describe technique of laparoscopic left posterior superior mesenteric artery first pancreaticoduodenectomy with
peri-operative outcomes and pathologic result. The appropriate patient selection for this technique and the critical step that may lead to conversion are also identified.

Materials and Methods: All patients who underwent this procedure were retrospectively reviewed. Demographic data, peri operative and operative results including morbidity and mortality were collected. The detailed technique of laparoscopic left posterior superior mesenteric artery first pancreaticoduodenectomy is also described including critical step that lead to conversion.

Results: Thirty-four patients underwent this procedure with peri-operative results, morbidity and mortality comparable to open pancreaticoduodenectomy.

Conclusion: Laparoscopic left posterior superior mesenteric artery approach is safe and feasible.

Keywords: Laparoscopic pancreatic surgery, Minimally invasive pancreatic surgery, Pancreatic resection, Pancreatectomy, Pancreaticoduodenectomy, Whipple operation