Background : In the modern-day pancreatic cancer surgery, ‘Artery first approach’ has proved invaluable to attain R0 resection. Six different SMA first approaches have been defined and are used more frequently in the open surgery. We present the technique of “posterior” SMA first approach along with ‘triangle’ operation for resectable pancreatic head adenocarcinoma using robotic approach.

Methods : Surgery was performed at Tata Memorial Hospital, Mumbai with daVinci Xi system using six ports (4 robotic and 2 assistant ports). Resection along with Triangle clearance was performed using posterior SMA first approach. Pancreatico-jejunostomy and hepatico-jejunostomy were performed. A small midline incision was taken for specimen extraction and for performing duodeno-jejunostomy.

Results : The procedure was performed in 600 minutes with a blood loss of 150ml and no intraoperative or postoperative complications. The final pathology report confirmed R0 resection, pT2N0

Conclusions : Both, SMA first approach and Triangle clearance are feasible while performing a robotic pancreaticoduodenectomy for pancreatic head carcinomas providing a radical clearance, in high volume centres with dedicated Robotic surgery programme for pancreatic surgery.