Laparoscopic pancreaticoduodenectomy via a reverse-''V'' approach with four ports: Initial experience and perioperative outcomes

Figure 1 Placement of trocars (A) and postoperative image (B).

Figure 2 Freeing the gastrocolic ligament exposes the inferior border of the pancreas and superior mesenteric vein. SMV: Superior mesenteric vein.

Figure 3 Mobilization of the duodenum and the proximal jejunum from right to left under the superior mesenteric vein (mobilization of the duodenojejunal flexure from the retroperitoneum). SMV: Superior mesenteric vein;

Figure 4 Transection of the jejunum.

Figure 5 Transection of the pancreas. Pancreatic neck parenchyma is divided with ultrasonic shears. SMV: Superior mesenteric vein.

Figure 6 Common hepatic artery and the gastroduodenal and right gastric arteries are identified and isolated from posterior to anterior. CHA: Common hepatic artery; PV: Portal vein.

Figure 7 After the pancreatic-duodenum removal. PV: Portal vein;