The left posterior approach to the superior mesenteric artery during robotic pancreaticoduodenectomy offers excellent outcomes, including a high rate of R0 resection and manageable complication rates.

• In a series of 27 patients, median operative time was 582 minutes with 100 mL of median blood loss.
• The approach resulted in an R0 resection rate of 89% and grade IIIa complications in only 7.4% of cases.
• Key factors for success include understanding 3D mesojejunal anatomy and maintaining precise resection planes.