# Pancreatic head clockwise devascularization technique during robotic pancreaticoduodenectomy to minimize intraoperative bleeding

## TL;DR

A new surgical technique for robotic pancreaticoduodenectomy reduces bleeding and operation time.

## Contribution

A novel pancreatic head clockwise devascularization technique is introduced to minimize intraoperative bleeding.

## Key findings

- The clockwise devascularization group had significantly shorter operation times and lower blood loss.
- No clinically relevant pancreatic fistulas or delayed gastric emptying occurred in either group.
- The median hospital stay was shorter in the clockwise devascularization group.

## Abstract

Pancreaticoduodenectomy (PD) is a complex procedure, and robotic PD (RPD) has been reported to have benefits in reducing postoperative complications. However, the timing and order for dividing arteries and veins remain unstandardized. We developed a novel technique, pancreatic head clockwise devascularization, to minimize intraoperative bleeding in RPD.

We retrospectively analyzed 39 patients who underwent RPD between April 2022 and September 2024. The clockwise devascularization technique divides 1) the gastroduodenal artery, 2) the 1st-jejunal vein branches, and 3) the inferior pancreatoduodenal artery + 1st-jejunal artery. Outcomes were compared with the conventional superior mesenteric artery (SMA)-first approach.

Of the 39 patients, 14 were in the clockwise devascularization group and 25 in the SMA-first group. The clockwise group had a significantly shorter operation time (616 vs. 772 min, P < 0.01) and lower blood loss (50 vs. 330 ml, P = 0.03). There were no clinically relevant pancreatic fistulas or delayed gastric emptying in either group. The median hospital stay was shorter in the clockwise group (5.5 vs. 8.0 days, P < 0.01).

The pancreatic head clockwise devascularization technique may be an effective technique to systematically devascularize the pancreatic head.

The online version contains supplementary material available at 10.1007/s00464-025-12070-z.