Total non-division technique of pancreaticoduodenectomy: A strategic integration of superior mesenteric artery-first approach and total mesopancreas excision

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This method combines SMA-first approach and total mesopancreas excision, improving R0 resection rates while reducing surgical risks.

The Total Non-Division Technique enhances R0 resection rates by deferring irreversible surgical steps until clear oncological justification.
Employing the SMA-first approach allows for early vascular control, safeguarding hepatic arteries and minimizing contamination risks.
This innovative technique supports intraoperative decision-making and reduces morbidity linked to non-curative operations.
A comprehensive strategy ensures safe integration of surgical principles while providing a flexible approach to potential procedure abandonment.

Warikoo et al. (2025) studied this question.

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