具有神经周围侵犯肠系膜上动脉 (SMA) 的胰头癌需要解剖 SMA 周围的神经丛（PLsma，肠系膜上神经丛）以获得无癌边缘。1,2 具有技术挑战性的机器人辅助胰十二指肠切除术结合 PLsma 切除术由于机器人的技术限制，很少进行。在这篇多媒体文章中，我们介绍了机器人辅助胰十二指肠切除术和 PLsma 解剖的方法。3-5 方法：我们对一名患有可切除胰腺癌的 78 岁女性进行了机器人辅助胰十二指肠切除术，切除了 PLsma 半圆延伸至胰十二指肠下动脉的根部。在本视频中，我们展示了如何使用多范围转换方法获得最佳视图，4 以及使用机器人进行 PLsma 解剖的技术技巧，以安全地进行这项困难的手术。手术时间为 568 分钟，使用了 300 mL 血液丢失的。病理诊断为浸润性胰腺导管癌伴淋巴结转移，行R0切除。距 SMA 的距离裕度为 2 毫米。患者于术后第 18 天出院，无术后并发症。机器人辅助胰十二指肠切除术，切除 PLsma 半圆，这是一项难以实施的手术，但通过多镜转换方法，可以安全地以最佳视野进行，并且精细使用机器人进行解剖。© 2024。肿瘤外科学会。

Pancreatic head cancer with perineural invasion of the superior mesenteric artery (SMA) requires dissection of the nerve plexus around the SMA (PLsma, superior mesenteric nerve plexus) to obtain cancer-free margins.1,2 Technically challenging robot-assisted pancreaticoduodenectomy with PLsma resection is rarely performed owing to the technical limitations of the robot. In this multimedia article, we present our approach to robot-assisted pancreaticoduodenectomy with PLsma dissection.3-5 METHODS: We performed a robot-assisted pancreaticoduodenectomy with resection of the hemicircle of the PLsma in a 78-year-old woman with resectable pancreatic cancer extending to the root of the inferior pancreaticoduodenal artery. In this video, we show how to obtain an optimal view using the multiple scope transition method,4 and technical tips to perform a PLsma dissection with a robot to perform this difficult surgery safely.The operative time was 568 min and 300 mL of blood was lost. The pathological diagnosis was invasive pancreatic ductal carcinoma with lymph node metastasis, and R0 resection was performed. The distance margin from the SMA was 2 mm. The patient was discharged on the 18th postoperative day without postoperative complications.Robot-assisted pancreaticoduodenectomy with dissection of the hemicircle of the PLsma, which is difficult to perform, can be performed safely with an optimal view using the multiple-scope transition method, and delicate dissection using a robot.© 2024. Society of Surgical Oncology.