A Unique Surgical Technique for Type III Portal Annular Pancreas using Hanging Maneuver and ICG Fluorescence Imaging

Robotic Pancreatoduodenectomy in a patient with Type III Portal Annular Pancreas (PAP) was successfully performed using the hanging maneuver and indocyanine green (ICG) fluorescence imaging. The technique involved transecting the pancreas into the neck of the anteportal portion and stapling the retroportal portion after dissection and encircling with hanging tape. ICG fluorescence imaging confirmed the blood supply from mesenteric vessels. The study highlights the importance of surgical strategy based on the fusion and ductal anatomy of the pancreas in PAP cases.