This case demonstrates robotic vascular reconstruction of the portal vein–superior mesenteric vein (PV–SMV) confluence during a robotic pancreaticoduodenectomy.

The patient is a 53-year-old man with biopsy-proven pancreatic ductal adenocarcinoma of the pancreatic head harboring KRAS G12D and TSC1 R245* mutations. Initial staging demonstrated borderline-resectable disease, classified as:

• Type A due to tumor involvement of the portal vein–superior mesenteric vein confluence

• Type B due to markedly elevated CA 19-9

He completed four cycles of neoadjuvant FOLFIRINOX, with favorable radiographic response and no evidence of metastatic disease.

The patient subsequently underwent:

• Robotic staging laparoscopy

• Regional lymphadenectomy for staging

• Robotic cholecystectomy

• Indocyanine green (ICG) cholangiography

• ICG angiography

• Robotic pancreaticoduodenectomy (Whipple procedure)

During dissection, tumor involvement of the portal vein–SMV confluence necessitated segmental venous resection with patch reconstruction.

Following en bloc resection of the involved venous segment, the portal vein and superior mesenteric vein were reconstructed using a bovine pericardial patch (V1 repair). The robotic platform facilitated precise vascular control, fine dissection around the mesenteric vasculature, and meticulous intracorporeal vascular suturing.

The video highlights the key technical steps of robotic venous reconstruction, including:

• vascular control of the PV–SMV confluence

• venotomy creation and preparation

• bovine pericardial patch sizing and orientation

• robotic vascular suturing for patch angioplasty

• restoration of laminar venous flow

The patient recovered uneventfully and was discharged home on postoperative day 4.