International expert consensus on precision anatomy for minimally invasive pancreatoduodenectomy: PAM-HBP surgery project

Yuichi Nagakawa, Kohei Nakata, Hitoe Nishino, Takao Ohtsuka, Daisuke Ban, Horacio J. Asbun, Ugo Boggi, Jin He, Michael L Kendrick, Chinnusamy Palanivelu, Rong Liu, Shin E. Wang, Chung Ngai Tang, Kyoichi Takaori, Mohammed Abu Hilal, Brian K.P. Goh, Goro Honda, Jin Young Jang, Chang Moo Kang, David A. KoobyYoshiharu Nakamura, Shailesh V. Shrikhande, Christopher L. Wolfgang, Anusak Yiengpruksawan, Yoo Seok Yoon, Yusuke Watanabe, Shingo Kozono, Ruben Ciria, Giammauro Berardi, Giovanni Maria Garbarino, Ryota Higuchi, Naoki Ikenaga, Yoshiya Ishikawa, Aya Maekawa, Yoshiki Murase, Giuseppe Zimmitti, Filipe Kunzler, Zi Zheng Wang, Leon Sakuma, Chie Takishita, Hiroaki Osakabe, Itaru Endo, Masao Tanaka, Hiroki Yamaue, Minoru Tanabe, Go Wakabayashi, Akihiko Tsuchida, Masafumi Nakamura

Research output: Contribution to journalArticlepeer-review


Background: The anatomical structure around the pancreatic head is very complex and it is important to understand its precise anatomy and corresponding anatomical approach to safely perform minimally invasive pancreatoduodenectomy (MIPD). This consensus statement aimed to develop recommendations for elucidating the anatomy and surgical approaches to MIPD. Methods: Studies identified via a comprehensive literature search were classified using the Scottish Intercollegiate Guidelines Network method. Delphi voting was conducted after experts had drafted recommendations, with a goal of obtaining >75% consensus. Experts discussed the revised recommendations with the validation committee and an international audience of 384 attendees. Finalized recommendations were made after a second round of online Delphi voting. Results: Three clinical questions were addressed, providing six recommendations. All recommendations reached at least a consensus of 75%. Preoperatively evaluating the presence of anatomical variations and superior mesenteric artery (SMA) and superior mesenteric vein (SMV) branching patterns was recommended. Moreover, it was recommended to fully understand the anatomical approach to SMA and intraoperatively confirm the SMA course based on each anatomical landmark before initiating dissection. Conclusions: MIPD experts suggest that surgical trainees perform resection based on precise anatomical landmarks for safe and reliable MIPD.

Original languageEnglish (US)
Pages (from-to)124-135
Number of pages12
JournalJournal of Hepato-Biliary-Pancreatic Sciences
Issue number1
StatePublished - Jan 2022

ASJC Scopus subject areas

  • Surgery
  • Hepatology


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